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From a founding partner about to retire, to an associate just out of fellowship, all five REIs at Carolina Conceptions sat down to share their takes on staying private, staying aligned, and staying real.
Carolina Conceptions invited us in, and we talked real talk about:
The golden parachute of private equity (and why they’ve resisted it)
The tension between high-touch care and the operational demands of growth
How they’re navigating succession, new tech, and alignment across multiple generations of REIs
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Griffin Jones (00:02)
Okay, here we go. My first five guests podcast. Let's see if I can do this. Dr. Bowling, Dr. Schointuch Dr. Johnson, Dr. Park, Dr. Meyer, Meaghan, Monica, Lauren, John, Bill, welcome to the Inside Reproductive Health podcast.
Dr. Lauren Johnson (00:18)
Thank you for having us.
Dr. Bill Meyer (00:18)
Thank you.
Dr. Monica Schointuch (00:19)
Thank
Dr. Meaghan Bowling (00:19)
Yeah, thank
Dr. Monica Schointuch (00:19)
you.
Dr. Meaghan Bowling (00:20)
you.
Dr. John Park (00:20)
Thank
you, Griffin.
Griffin Jones (00:21)
This isn't how it happened, but John, this is how I'm going to tell people that it happened, that I invited you on the show and you said, no way, Jones, it's all five of us or it's none of us. That's how I'm going to tell people that it happened. But I actually do think that it is interesting that I invited you and Bill on because I'm a little bit more familiar with you two. And you said, well, what about the rest of our group? And I think that speaks to something. Why was that important to you?
Dr. John Park (00:52)
we're definitely a team here. also with this particular topic that you wanted to cover, I felt like we all had something to contribute here. ⁓ Out of the five of us, ⁓ Bill and I have been here the longest, but we have people at various stages of their career. And so just felt like this episode could be a lot more interesting to get all five of our inputs on the topic.
Griffin Jones (01:22)
That topic being, I've got a pulse on independent practices, or I always try to keep a pulse on independent practices, and I think that the future is, there's multiple avenues of where fertility practices might go. For you all, where do you want your practice to go? When you sit together, how do you articulate what you want?
the vision to be and then how do you all align around it?
Dr. Bill Meyer (02:02)
You didn't think that any of us would not talk, right?
Griffin Jones (02:04)
⁓ This is like the default.
Dr. Bill Meyer (02:08)
I mean, really don't,
we don't that we, you know, honestly, most of the time, we don't sit around and talk about which way we want the practice to go. We just kind of deal with, you know, daily and weekly problems, I think. I think uniformly, we've all this, the partners have at least discussed private equity and venture capital takeovers before, but we really, you know, in the past, we were interested in a couple of times. And I think
the junior partners look towards the senior partners because we've dealt with that in the past. And I think everybody's impression is about the same. So.
Griffin Jones (02:46)
Which is what?
What's that impression?
Dr. Bill Meyer (02:49)
Right now we're comfortable staying independent.
Griffin Jones (02:53)
Is there a tension between the senior partners and the junior partners? Because what it seems to me is that it's a different value proposition depending on what stage of your career that you're in. And so it might be really good for you, might be, that could be the golden parachute. Why also look at the junior partners as opposed to
looking out to what might be in your best interest.
Dr. Bill Meyer (03:26)
Yeah, well I think it's the reason why we all are talking about myself since I'm the senior partner went into this initially anyway. It wasn't really for the golden parachute. It was, you know, take care of patients live comfortably and you know, kind of be your own boss. And, you know, as of a couple years ago, we were approached in by, you know, venture capitalists again and an outside group. And I think it's a
I discussed it with the junior partners. Hey, do we want to go any further with this? And some of the other doctors here tonight will kind of talk about that a little bit. you know, I think from everybody, anytime we have been approached before, I think we've all gone out and talked to other members, other people that we trust, fellows we trained with either or worked with in academics or when we were in a fellowship. And I think the experiences of those folks, even if it was a golden parachute,
⁓ The way the practices were left was not something that I would want to leave a practice with. I think we all have kind of a reputation to kind of leave behind us. And I think in a lot of these golden parachute cases, the physicians who stay behind are not necessarily the ⁓ happiest in their position.
you know, taking a golden parachute, you still have to work with people, you still have to take care of patients and you still have your reputation. So I think that and based on the experience of other practices, the reason that we never went that
Griffin Jones (05:09)
I want to come back to that thought about the Golden Parachute and ⁓ physicians not always being the happiest. But who's the newest to this crew? that you, Monica? How long have you been with the group?
Dr. Monica Schointuch (05:22)
What mean?
It'll be two years in September.
Griffin Jones (05:27)
Why did you decide to join this crew?
Dr. Monica Schointuch (05:30)
Yeah, well, for one thing, the people, right? I think that's pretty self-explanatory. Once you meet them, they're a great crew. It just felt like an excellent fit. They're all amazing doctors. And for me, when I was looking for practice, the big pieces of the puzzle, if you will, that I looked at were really just pregnancy rates, because I knew I wanted a place with a great lab where I would have success in getting my patients pregnant. And so that was important to me.
the reputation of the practice was really important to me. And Carolina Conceptions is like a very well established practice in Raleigh. And it's like one of the largest, ⁓ not to mention the physicians who have currently worked there because I would need to see them daily. And they have very much so become my mentors and has helped me ⁓ grow as a physician, which is excellent. And then the other piece of that puzzle, which I think speaks a lot to that portion of like
private equity versus being privately owned is like the ability to like truly feel like I can care for my patients and provide individualized care and like protocols that I think that would be best for that patient and not necessarily fall into like a templated or like routine type of treatment. But.
Griffin Jones (06:47)
So would that put you at fellowship class of 22 or 23? I don't know if you all downloaded our fellowship placement list of 24, but do you all know how many fellows from last year's class went to work for independently owned practices of the 60 or so fellows? I think there were 60 fellows. Seven, seven of the 60. So I...
Dr. Monica Schointuch (06:51)
23.
probably very few.
Griffin Jones (07:16)
We didn't do that in 2020. We'll do it going forward. We didn't do it in 2023. I'll assume for the sake of this conversation that it was a similar number. Why did you choose to be an outlier though? mean, I get the benefits that you saw in this group. But it seems like the the so many fellows are saying yeah, but and they're choosing to go work for private equity back networks. What
made you decide to go in a different direction.
Dr. Monica Schointuch (07:48)
Yeah, so I forget what conference it was, but they were talking about your first position that you take out of fellowship and the likelihood that you actually stay with the practice that you sign with. And I think at that point, the rate was like 50 % of people or so will leave the first practice that they sign with and go elsewhere. And honestly, like I'm very much a homebody and I knew that I wanted to sign with a practice that I would get to stay with like forever, hopefully, right? Knock on wood, I know I'm not a partner yet.
But I was just like truly looking for that 50 % or like my forever. And so I think as a fellow, when you step out, you look for comfort, right? Like where am I going to be most successful and be able to like out see my career out? And I could see how sometimes private equity, especially since there's like in lots of locations, and that may play role as well, how that might be an easier choice because there is some stability in that.
However, for us, it's just such a different context comparative to other ⁓ privately owned, physician owned clinics. I don't think it's really common to have five docs. I don't think it's very common to have such a well established practice that does so well even with pregnancy rates and success rates. And we also have four different offices. We're not a small group. And so I truly.
when I interviewed here after meeting the docs and seeing how big the practice is, I felt that same comfort that I think you would get when interviewing with a private equity company. So to me, that longevity, if you will, of the job was there. And so it made that decision much easier. Of course, there's differences as well as you continue through that partnership track. That looks very different regardless of where you are or where you sign.
which Dr. Park was very helpful in describing when I was joining, because you don't learn that much about that in fellowship. But I think, you know, knowing that I was joining a practice that was solid, that had been here for years, that had that longevity and that high pregnancy rate is like the perfect mix to make me feel comfortable enough to make that jump.
Griffin Jones (10:03)
It's not common to have an independently owned practice with five REIs anymore. It used to be common. They all got bought up for those golden parachute reasons. So you're still in the associate role. Bill and John, senior partners. Monica, Lauren, you the, sorry, Meaghan and Lauren, are you the junior partners? Are you both partners at this point?
Dr. Lauren Johnson (10:06)
Thank
Dr. Meaghan Bowling (10:30)
partner yeah and Dr. Johnson.
Dr. Lauren Johnson (10:33)
and I
am planning to be a partner in ⁓ 2026.
Griffin Jones (10:39)
All right, so let's talk about that for a second, Lauren, because I met you a few years back at an ASRM roundtable. And I don't even remember what topic I had, but I do remember that you were with a practice at that time. I think it was, ⁓ think everybody knows the IntegraMed story. And then everybody that worked for any IntegraMed practice was faced with, well, what do I do now?
Dr. Lauren Johnson (11:01)
Mm-hmm.
Griffin Jones (11:08)
many of those folks decided to go independent, many of them decided to go for networks. That would have been the opportunity for you to say, okay, I'm gonna go for a network. I do remember something, just something that you were a little bit more forward thinking than I think I see many associates being of like, yeah, but somebody else could still come in and buy this thing. And
is, you know, somebody else could come in and swoop in, you were a little bit cautious about that or not. Maybe cautious isn't the right word, but thoughtful. Can you tell me about your thought process at that time?
Dr. Lauren Johnson (11:47)
Yeah, I think when we met, I was still ⁓ with an integral med practice and really getting introduced to ⁓ kind of what the concept of partnership ⁓ looks like when you're part of a private equity group. I think at that time, I was still kind of wrapping my head around it. ⁓ It was not something I got any education about in fellowship. ⁓ I'm just very honest going into private practice, really
didn't understand it, didn't know a whole lot about it. ⁓ And I think kind of the more I learned about it, ⁓ I definitely had, I think caution is a really appropriate word to use there. ⁓ It was, again, not necessarily what I expected. What my understanding of a private practice was is what I have now, right? That the physicians own the practice and when you get to be a partner,
buy into the practice and you own equity in the practice. And I assumed that that's how many private practices worked. ⁓ I was exploring that, I guess, at that time of what does it really mean to be a partner in a practice that's partnered with private equity?
Griffin Jones (13:09)
What type of answer did you come to? What does it mean in the alternatives that you chose not to pursue?
Dr. Lauren Johnson (13:12)
Yeah.
Yeah, I mean, ⁓ I'm certainly not an expert in this area. I feel like ⁓ there are a lot of answers to that question. And I feel like I've heard of different models for that. ⁓ There are certainly models ⁓ where being a partner essentially is access to ⁓ a revenue stream of the company, but not necessarily ownership ⁓ of the company or the assets or any part of that. So that's that, you
That concept was new to me at that point, but it's part of a partnership model, I think, in some private equity-backed practices.
Griffin Jones (13:58)
Meaghan, you're in such an interesting position in my view. You've got two senior partners, you own equity, two young docs in the pipeline, hopefully coming up right behind you. What do you want out of this?
Dr. Meaghan Bowling (14:04)
You
Yeah, I'm like the middle child here or something. ⁓ I mean, I've seen it from both sides. I think when I started here, I always had it in the back of my mind, feeling like a little bit of nerves. Like, what if they sell the practice before I make partner? And so I think that can be a fear of a lot of kind of lower level associates in these practices. ⁓
But I think part of the great thing about our practice is that we are a team and part of the reason I joined this group is to have ⁓ this amazing group of doctors that I work with and we are like.
We are an amazing clinic here in North Carolina and that kind of power and success that we have from being one of the top clinics in our state just feels really good from a success standpoint to be surrounded by other doctors who care as much as I do about being the best every day. so.
So you start to kind of lose a little bit of that fear. And then it's amazing when you become partner and you feel like, wow, I've got this kind of security now. But the other thing I see is that I'm really excited for Dr. Showentuck and Dr. Johnson to kind of join us as they come through. I think what it shows is the longevity of our practice that, you know, Dr. Meyer.
has started this amazing group and Dr. Park has built it up so much and that's what we all want to continue to do. ⁓ And so I'm excited to have the experience with the older partners and see myself as growing and becoming one of the older partners with some of the other doctors who really aren't that much younger than me.
Dr. Lauren Johnson (16:10)
haha
Griffin Jones (16:10)
I
like how you made that, you wanted to say that the younger partners aren't that much younger than you, as opposed to saying the older partners aren't that much older than you. I'm gonna do a sponsorship read right now, ⁓ do the sponsorship read twice during the episode. So Caleb will edit this part out. Normally I'm like a 20 year old YouTuber now, I'm so good at.
Dr. Meaghan Bowling (16:13)
Hahaha!
Dr. Monica Schointuch (16:14)
That's for co-operation.
Dr. Meaghan Bowling (16:16)
you
Yeah.
Griffin Jones (16:38)
doing the segue of the sponsorship read. So the next time I do it, I'll just kind of put my two fingers up so that you know that I'm doing it because I cut into it then I cut back out. So I'll do that read and then I will and then I'll get back into... I'll fire into the next question. For those of you that are interested in a golden parachute, if you're a fertility practice owner, you're another owner of a fertility business, you're looking for ways to increase the value of your
practice. Think about an exit, assess some sales strategies, meaning selling your business. MidCap advisors can help you. MidCap will work with you to help you understand your practices, current transactional value, its value drivers, and also provide practical ways to maximize your practices value. This is what these guys do for a living. Dr. Minhas was a practice owner. He was a lab director.
Bob Goodman worked in as a healthcare administrator for decades. Richard Goldberg has done so many deals in the fertility space. They all work for MidCap. Now, they'll assist you with implementation, keeping you fully informed on changes in the mergers and acquisition marketplace writ large so you know what's going on. So if you're thinking about that next chapter, even if it's not in the next year, it's five years down the road, maybe even longer.
talk to those guys, MidCap can help you think about all of that stuff and we'll include their contact information. Thinking of the golden parachute, Meaghan, your situation is different from where it is in Bill and John's spot. From my vantage point, I don't see a ton of upside for younger doctors because I think if like, if there's somebody else that owns 70 % equity and then the
senior partners are left with 20 or 30 % equity, and then you know, they're cashing out, there's just not much left to bring in younger docs, for them to like have a real upside in the long term. Maybe I'm missing something. That's how I view a situation similar to yours. But are you the one saying like, hang on guys, let's, like you're in a different position than they might be. So
Do you find yourself having to advocate for that?
Dr. Meaghan Bowling (19:04)
You know...
not recently. mean, when I came on before I was partner, think maybe Dr. Park and Dr. Meyer can speak to it more. ⁓ You know, we were approached by by groups and at that point I wasn't partner yet. And so I wasn't as much part of those conversations. But ultimately, I think, you know, Dr. Park and Dr. Meyer kind of reached the decision that it wasn't worth it ⁓ to sell. And so ⁓
as we've had a few more offers, I think, since I've become partner. And it's already kind of like our decision is kind of made here. ⁓ And so kind of less, we're kind of less likely to kind of entertain those ideas at that point. So I haven't really had to, I think the whole group is kind of on the same page.
Griffin Jones (20:01)
Bill and John, how many years are you guys apart? Nobody has to reveal, never ask REI his age, but I mean, how many years are you all apart in terms of when you started?
Dr. John Park (20:15)
Some of us have aged better than others.
Dr. Bill Meyer (20:15)
We're only two months apart in age.
Dr. Lauren Johnson (20:18)
You
Griffin Jones (20:20)
I thought so. Yeah. Yeah, and we should
Dr. Bill Meyer (20:20)
Yeah. Yeah.
Griffin Jones (20:26)
clarify, the other doctors aren't that much younger than you all. How many years more do you wanna work for if I can put you on the spot in front of the 20 million people that listen to this podcast? When you think about it, how many more years do you wanna be doing this for?
Dr. Bill Meyer (20:31)
Yeah, right. Yeah.
Well, they already voted me out. So this is my last video. I already know. And they actually, already have a calendar up. pull off the days as they go on. I'm retiring at the end of the year. So they are, it's gonna be the four of them come January 1st of 2026.
Dr. Monica Schointuch (20:52)
None of us.
Griffin Jones (21:10)
This is so this is this is news. Is that so you're not you're not joking about that part. You're you're retiring at the end of the year What about you John?
Dr. Bill Meyer (21:14)
No, no, no, yeah, yeah, yeah.
Dr. John Park (21:20)
Griffin, I'm in my early 50s, so I plan to continue working for quite a while.
Griffin Jones (21:24)
So then Bill, you're really in a ⁓ different position. So I wanna push you on the golden parachute thing for a second because I've just heard so many darn times what you've said and I believe the sincerity of what you said, of that you care about the people that you're leaving behind. The legacy is important to you. You've seen other people not be so happy afterwards and maybe have a little bit of seller's remorse.
And I believe in the sincerity of what you're saying. I've also believed in other people that have said similar things and believed in their sincerity. But I just think it's it's like grandpa's farm. We'll never sell grandpa's farm. We'll never sell grandpa's farm. Until somebody comes and offers us way more money than we ever thought grandpa's farm should be worth. And then you really, and then you start to think, well, gosh, with that.
much money. could donate to the causes that grandpa cared about. could buy a new fund for all of grandpa's college. We could do a college fund for all of grandpa's grandkids. We could do a big family reunion trip every year and not cynically, but truthfully challenge those things that they thought were important when they're faced with that kind of golden parachute.
Dr. Bill Meyer (22:43)
Yeah, okay. All right. So maybe it wasn't sincerity. Maybe it's ignorance. ⁓ But you know, when Dr. Showentuck was talking, I was just thinking when I got out of fellowship, they didn't talk to us about, you know, we weren't debating whether it was private equity or venture capital or just going into independent practice. was, you going to stay in academics? Are you going to go into private practice? So was totally different then. And when I left the university to form this,
we weren't, private equity wasn't that big of a deal at the time. It was, it was in a different way. wasn't the finances, but it was almost getting away from private equity in the sense that you were kind of getting away from big brother. You were getting away from the university and all the regulations and meetings and lack of control that you have when you're working for a university is why you go out and, or at least one of the main reasons we went out.
and set up a practice almost 20 years ago. So I think there is sincerity in the fact that, the money wasn't the primary factor that we went out. It was to keep our autonomy. And so when you talk about Golden Parachute and all the money, first of all, all five of us are going to do well financially. Could we have done that much better if they bought out in the future? Possibly.
But, and I'm not trying to sound, you know, you know, haughty about it, you know, how much money do you actually need to be, you know, satisfied with things if your life is comfortable and you have control of your practice, you have a good group of physicians you work with and you can take care of patients. ⁓ So, know, people, when they talk about the money situation, you know, I think the autonomy is,
one of the main reasons. ⁓ You know, when I knew we were going to this talk, was thinking of different scenarios, but I would think it would be extremely frustrating being a physician having gone through all the training we've gone through to have a business person who hasn't done any medical training tell you that how you should take care of patients. I mean, I think that would be the most frustrating thing.
Now, would it be a different situation if we hadn't been a successful practice? ⁓ Griffin, when we opened this, and we were in so much debt to open this, I opened this with a physician from one of the other universities, Dr. Couchman. I we were in debt and we were spending a lot of money and actually IntegriteMet approach us. And it was, I talked to business associates because we almost went with IntegriteMet. There were two reasons. Number one, they needed three providers.
before they would consider you and we only had two providers. So we didn't do it. And then most business people who had done it, they said, you you sell out the private equity, you sell out the venture capitalists, most people will regret that in the long run. And if you can just hang it together for a while and get over that, you know, that initial debt, it'll probably pay dividends in the long run. Not just monetarily, but being able to take care of your practice and your patients.
Griffin Jones (26:02)
I see the autonomy argument crystal clear if I'm in Meaghan or John's position that that's why I like owning a business. I like being able to call the shots and do what I think is right. And I think it's really different when you have investor obligations or you have other shareholders to behold. I can decide how much people are going to make. I can decide how much we have to work.
you can do the right thing when you have to and you're only accountable to your own top line. I think it makes sense in the stages of career where they're at. For someone that's going to retire, think the situation's a little bit different because, well, you just say, I'm going to eat crow for two or three years, not have autonomy. I'm going to be somebody else's employee after having ran this ship for however many years. but, but it's the
price that I'm paying for this huge multiple that they're giving me. For you...
Dr. Bill Meyer (27:07)
Yeah,
I got you. And so there's a couple of reasons why even if I had wanted to maybe one to do that, I wouldn't have done it. Well, number one is I ran it by the, you know, I ran it by Dr. Dr. Bowling was younger at the time, but, know, we got approached and, you know, talked to him about, is that something you want to do? And, you know, we listened to people and yeah, they paid us money and we made, we would have made a lot of money initially, but then things kind of evened out over the long run.
compared to how we're doing. ⁓ The other thing too is how we have our voting structure, not to get into it in depth, but I don't have 100 % of the vote. In fact, how we have it structured, even if I had wanted to and another person in the practice had voting, they would have voted that down if they had wanted to. So I didn't have complete control on the voting of how the practice would go.
Griffin Jones (28:08)
John and Meaghan, do you see the opportunity for groups your size to merge together, maybe in acquisition, maybe in cashless merger, but not private equity backed? I'm thinking of something somewhat akin to the growth of Shady Grove where they did some acquisitions, but they grew for a long time before they were private equity owned. And they did so with...
they had an executive leadership in place, but it was physician owned. Do you think that's possible for you all to merge? And I'll just make up some doctors names like John Schnorr, Sam Brown, John Nichols, John Payne, Sam Chantilis. Do you think it's possible for you guys and others out there, you guys and gals, to form a really awesome physician-owned network
Dr. John Park (28:45)
Ha ha.
Absolutely. Network.
Griffin Jones (29:06)
Like is that still, like is that a possibility?
Dr. John Park (29:10)
Yeah, absolutely. We know that this happens in other specialties. I just spoke with someone the other day in dermatology, also dental practices. So there are independently owned networks that are not backed by private equity. And, you know, we've had some brief conversations with others about doing that. So we know that it's possible, but it's still there's a lot to be gained by that, you know, for example, the economies of scale.
being able to negotiate with vendors to get the deepest discount possible on certain supplies. But as you start doing that, you still are faced with some of the issues that you would also face if you were joining a network backed by private equity, such as the loss of autonomy, the lack of freedom to be able to choose what culture media you want to use, what catheters you want to use, because
giving that up comes with the ability on the business side to use the large numbers of a network to leverage that to reduce your costs. So we'd still be facing some of the disadvantages that we'd face if we were joining a network backed by private equity. And so at this point, we're still not interested in doing something.
Griffin Jones (30:30)
Let's talk about the flip side to those disadvantages. And Meaghan and Lauren, I think you're in the bracket that probably has to think about this. thing that I, so I see the benefits to consolidation and I see the cons. One of the cons that I see is I don't like the limited concentration of buyers. I think it's not good for the field. I think we need more groups your size, more five, 10, 15 doctor privately owned groups.
to help spur innovation, because what's happening right now is you've got six or eight networks that are really dominating a lot of the buying. And so a lot of the solutions that are emerging, they need to either hit a grand slam or they're done. The barrier to entry is almost zero sum. And if there was ⁓ a ⁓ more distributed ⁓ pool of buyers, still of decent economies of scale,
I think we'd start to see more solutions get adopted. On the flip side though, what I see is I really do believe that IVF is going to become a high volume field of medicine. I think whether it comes from the political mandates or simply the employers merging or going the insurance route or the EBM route in a more concentrated way that it is going to be a higher.
volume field of medicine. so operations need to change to be able to see a lot more patients to do a lot more retrievals. And as you said in the beginning, Bill, oftentimes independent practices, they're worried about the problems that are in front of them. You're so committed to the delivery of care, that it's hard to work on those those systemic issues. So Meaghan Lauren, how do you see this is ⁓ how do you take time from I've got to do
⁓ X number retrievals and X number of ⁓ see X number of patients as a physician to actually then put on a business hat and say, here's how we're going to innovate the practice at a systemic level.
Dr. Lauren Johnson (32:43)
Yeah, I think it's a really good question. I mean, I would, I would credit, you know, John and Bill for, for a lot of those ideas and having kind of that real, that global mentality. Yes, we deal with the problems in front of us. But some of the problem that's in front of us is, okay, well, to grow, we have to, you know, have an office in another location. We need to capture a different part of the community that we serve. And
And I think it's a balance, right? I think for us, that sort of planning has come out of ⁓ what do we need to grow and get better? And what does that solution look like for us? ⁓ So I think it's been more of an organic process of how do we capture more of the market share and do that in a way that is really true to the culture of the practice. ⁓ And I think that we've been successful in doing that. We just opened our fourth office.
which is already very busy. ⁓ I'd say I would especially credit Dr. Meyer. He's always thinking outside of the box and always pushing us to think about things differently, which I appreciate.
Griffin Jones (33:56)
putting you all in the spot now. What are some technologies that you've adapted in the last two or three years that you didn't have before that was a response to your growth?
Dr. John Park (34:13)
I think the biggest one, Griffin, is upgrading our EMR. That was so instrumental ⁓ with opening up new satellites and with our ability to do so many remote consults, both on phone and virtual. ⁓ The ability to monitor patients when they're going through treatment at any different satellite. We follow our own patients so we can monitor their ultrasound findings, their lab.
results from anywhere. ⁓ And so that's really helped with patient care because prior to this current EMR, we weren't able to do that.
Dr. Meaghan Bowling (34:52)
think one of the changes I've seen as well besides enacting this new medical record system and besides the adding new locations to bring in patients is that ⁓ we, ⁓ I just lost my train of thought. ⁓ I think one of the things we've seen is that there's been a huge shift in how many, I mean, we're in the South, we are in North Carolina and we have, ⁓
actively work to partner with ⁓ groups that provide some sort of financing for IVF. I know that ⁓ I share your dream that this is going to become a.
you know, a field where they're going to be, you know, we're going to be doing thousands of ag retrievals. But the current day and age, we just don't see that. They're very, you know, I think we are limited by geography and how many other clinics are in the triangle with us, ⁓ that we all compete for a limited number of patients. And so by, ⁓ you know, we bring in patients in ways to kind of make IVF more affordable. We do that by Dr. Park being part of ⁓
research projects that provide IVF cycles for free for patients who don't have insurance. We partner with Progeny, Maven, KindBody, we bring in more patients with insurance, these carve out programs. So I think compared to when I started even just five years ago, maybe like 15 % of patients had.
insurance coverage in North Carolina. ⁓ And now we're seeing a switch to like more and more patients or 60 or 70 percent having some sort of coverage. And so I think making ourselves available to these other groups and showing them how strong they partner with us because we have strong success rates and we have strong success rates because we've remained independent. We've actively worked to ⁓
know, anytime we see any problems with pregnancy rates, we're on it and we're analyzing our protocols and seeing what can we change? What can we do different? We enact it the next day and we're able to make changes that we are able to kind of keep our pregnancy rates high so that groups like Gaia and Progeny want to work with us. So I think that's another way we've kind of enacted it.
Griffin Jones (37:12)
So, guys, I think you ended up finding out about them all through Inside Reproductive Health, if I'm not mistaken, John, you told me that ⁓ when we met with them at ASRM. So I love hearing that come full circle, when you heard about them through us, but also that it's one of the things that you're happy about. Tell me about the EMR. Who are you with now and what do you like about them?
Dr. John Park (37:39)
We're using Enable now and ⁓ Dr. Bowling is the one who kind of spearheaded the process of going through the screening process of seeing what products were out there, having arranged for demos. ⁓ Enable really was just the best fit for us in ⁓ following the workflow of patients. ⁓
looking at the treatment cycles, the work lists, how that is populated and how it's customizable. ⁓ So it was really just the right fit for an office that had multiple satellites where we don't have one particular physician tied to one particular satellite. ⁓ So we tend to rotate around. We'll take turns driving out to our Wilmington office.
And so we needed the ability to follow all of our patients regardless of where they were geographically.
Griffin Jones (38:37)
Did you do some vetting? Meaghan, did you go through a bunch of demos and how did you come to that decision?
Dr. Meaghan Bowling (38:44)
Yeah, we, this is like years ago. We did it right after COVID, but ⁓ yeah, I think we were looking at, I think we had narrowed it down to three, I think Artisan was in there. I think we had, ⁓ and we ended up just vetting them. I initially vetted them. I think we got it down to Artisan and Enable and then ultimately kind of decided on Enable.
Griffin Jones (39:11)
What was the deciding factor for you?
Dr. Meaghan Bowling (39:14)
That's a great question. I don't remember now. I think...
Griffin Jones (39:20)
Well, too late now, you ain't changing now. Once you change an EMR, it's like the best EMR in the entire galaxy could come out the next day and people would say, talk to us in five years or never.
Dr. John Park (39:23)
Yeah.
Dr. Meaghan Bowling (39:26)
I can't!
think there was something to do with cryo management, John. Is that part of it where they monitored the cryo for us and that wasn't available with the other groups we were looking at? There were little pieces. There wasn't anything major. ⁓ Again, it just felt like a better fit for us overall.
Dr. Bill Meyer (39:58)
What they did was they stuck me in a room with it and they said if he can figure it out then we're going to do okay.
Dr. Monica Schointuch (40:05)
is abuse.
Dr. Lauren Johnson (40:06)
Yeah. Yeah.
Griffin Jones (40:06)
And
you got through it, Bill, you got through the maze.
Dr. Bill Meyer (40:09)
It took me three
years, but yeah, I think I got a handle on it now.
Griffin Jones (40:14)
When I talk to Mark Amos, he owns a group called New Direction in Phoenix. It's a pretty high volume center. He's doing 80 new patients a month. He says each of his docs are as well. They have advanced practice providers. so what he thinks is going to happen is that he gets, I think right now he's doing two visits, the follow-up and the new patient consult, with using some automation and tool like
Levy Health and some other things that he'll be able to, they'll be able to see one patient in a 30 minute visit for, so that's a condensed, the first visit and the follow-up. And he thinks that they'll be able to increase their new patient per doc by at least 50%. So let's say, 120, 150, maybe more patients per doctor per month.
Do you all see yourselves having to get on a model that can do that within the coming years?
Dr. John Park (41:25)
our patient volume isn't that strong, Griffin. There isn't a need for us to take on that kind of volume. I think it would be really difficult to get to know your patients and to be able to really follow them and individualize their care when you're working with that kind of numbers. But that's not an issue that I think we're going to be facing anytime soon. I think, you know, to kind of go back to one of your questions you asked earlier about, you know, where we'll be in the future, we
You know, there's in our area, there is this lane for independent practices and we've had this slow, steady organic growth since Dr. Meyer founded the practice. ⁓ And so many patients are coming to us just from word of mouth. A lot of patients come show up and say, you know, I started at this one practice, but I was talking to my friends once I started getting involved in this whole fertility process.
And I, turns out I had three other friends that had been to Carolina Conception. So I decided to switch. That happens all the time. And so we have this advantage of being the most established private practice in the area. And that really works to our advantage. And I think that we will continue to see this organic growth and a lot of the success I think is attributed to the ability to really get to know our patients and walk them through the process. So I think that would be really hard to do with a hundred new patients a month.
Griffin Jones (42:54)
What if for the first time ever a politician actually did what he said he was going to do and IVF is paid for by either the government or all insurance companies and now there's a handful of payors and they say, here's what we're paying and everybody's covered and that change is saying, what if something like that happens?
Dr. Monica Schointuch (43:21)
We'd probably hire more physicians immediately.
Dr. John Park (43:27)
more physicians and more APPs, we would figure out a new system and we've already had conversations of how to get patients in the door, triaging them to seeing an APP for an initial consult versus an MD. ⁓ But, you know, don't know if there's any new technology that will really help us increase the volume or increase our capacity of getting patients in the door.
Yeah, I just don't see anything right now. And I think that if something were to change with legislation, that we'd be aware of it and we'd be able to make some changes to help accommodate that increase in volume.
Griffin Jones (44:11)
Are you passively or actively hiring new docs now? There's a lot of fellows that we got the third years, second years and first years that tune in fairly regularly. If some of them are interested in the Carolinas, how open is your door right now?
Dr. Meaghan Bowling (44:32)
say it's open. ⁓ Yeah, I mean I think with, you know, we know with Dr. Meyer retiring that we definitely are going to need another physician ⁓ probably fairly soon. So yeah, we're definitely on the lookout. I'm certainly, I will be at ASRM ⁓
this year, so if anyone wants to reach out to me, ⁓ I'm happy to meet with you at ASRM if we have any interest from fellows.
Griffin Jones (45:05)
Bill, are you gonna sell the seven C's or are you ⁓ gonna stick around and be there to pinch hit? Maybe see a couple patients if Monica gets sick or if somebody's going on vacation. Are you gonna do any of part-time thing?
Dr. Bill Meyer (45:20)
I think they would get sick if I did that. No, no, no, there's no way. I'm ready. I'm ready to go. They're going to do great. ⁓ Yeah, I want to do some other stuff, know, family stuff, traveling. We know what everybody says, right? That's why I want to do some of that stuff. It's going to be fun. I want to come back and I want to hear how they're doing. I think they'll do well with things. ⁓ But yeah, I'm ready to I'm ready to pack my bags and go.
It's been fun. We got a great group. I mean, it's great to turn it over to four great docs ⁓ and see how it's going to go. It'll be fun to see. Watch from the outside in. It'll.
Griffin Jones (45:51)
Fur.
For those
that are ready to sail around the world, they're ready to go. And you're thinking about that next step. You're thinking about selling your practice, stepping back from ops, or just focusing on medicine more than management. You might want to talk to the folks at MidCap. They can help you figure out what comes next. They'll work with you to understand your goals. They will help you. get into the books a little bit. They do this all for free, by the way. They don't charge a retainer or anything like that. They explore options like selling to a larger group.
They're very patient, a little too patient in my estimate, but that's why the people they work with like them and trust them so much. They'll take a look at merging with P-backed groups. They'll look at the model that's best for you, merging with other groups or selling or strategic opportunities. And they'll run that competitive process to find the right fit and they'll handle all of that stuff for you. So if you're thinking about your next chapter, get in touch with the folks at MidCap Advisors. We'll put their contact
in there. For this great group of docs that's taking over, we do have a lot of younger docs that are listening and maybe not just fellows, but folks that have not found their forever home yet and maybe have been practicing for a couple years. What advice do you have for them?
Dr. Lauren Johnson (47:21)
I would say to really focus on being honest with yourself about what you want in a practice ⁓ and what environment you want to practice in long term. ⁓ I would, if we haven't said it before, I would say it now. mean, our practice has an incredible culture in terms of the physicians that work here. And when I was making a decision about
where I was gonna spend the next part of my career, that was a huge, a huge part of it. ⁓ Do I like the people that I'm gonna spend at least 40 hours a week with, right? Do I wanna see these people? Do I wanna interact with them? ⁓ Are they good doctors? ⁓ Can I trust that if I go on vacation or I'm out for a day, that they'll take good care of my patients? I think that's really important. I think also looking,
at the values of the people that you would potentially practice with. think one of the things that has made this practice really strong is that we are all similar in our value structure and what we want and how we want to practice medicine. That doesn't mean that we are all the same, ⁓ but I think at heart we have the same values and we can sit in a room and be honest with each other and talk about when we don't agree and then
have enough respect for each other to say it's more important that we talk about it and we come to a conclusion that's right for us as a group. So I would say that those intangibles are really important. And then also looking at practice structure, like we've talked about in terms of independent practices versus private equity, there's not a one size fit model and different people will land differently on that. But I think,
Dr. John Park (48:59)
you
Dr. Lauren Johnson (49:15)
a lot of people look at private equity and think, there's a lot of, I feel safe, I feel comfortable. They're a big network. ⁓ There's not anything that's going to happen to me there. And maybe they look at an independent practice and feel like, ⁓ is there as much of a safety net? And having gone through the IntegraMed collapse, I can tell you that you can be very vulnerable in private equity. And at the end of the day, you know,
You have to decide how much autonomy you want in your practice and who do you want at the table with you 10 years, 15 years down the road, right? At a small independent practice, I know who's gonna be at the table with me, right? It's the people I'm looking at on this podcast. I know their values, I know what they want. ⁓ You can't always say the same thing in private equity because someone else is gonna be at the table with you in 10 years.
Griffin Jones (50:08)
Monica, how do you keep that value alignment as new folks come in? Because I think you got lucky with the Bill Meyer. I'm not blowing sunshine, Bill. I really I think that it's noble. just I think that there are so few people that it can really be at a position that that that Bill has been in and say, I've made enough money. I'm good. There's there's just not a lot of those folks. And so you've you've you've gotten
maybe lucky is not the right word, but fortunate in that you have this group. But how do you keep that going that as you got docs coming in five years from now, 10 years from now, 15 years from now, that you make sure that you keep those values aligned?
Dr. Monica Schointuch (50:56)
Yeah, I think Dr. Bowling said it well towards the beginning where she said when she joined, she like always had that thought in the back of her mind of like if they will sell the practice before she makes partner. I think like, right, that's like a very easy thought to have. And it's one that I think commonly probably even Dr. Johnson has thought of a couple of times and I definitely have thought of myself. It's like that question of stability, if you will. But on the other hand, knowing
that these people are who they are and having met them a couple of times during the interview process and really seeing that core value, I felt safe enough to really accept that possibility, but knowing that that likely wouldn't happen and that it's like the fear of the unknown, right? So I think like when you join a practice that it's not private equity, there's always that potential for it to be purchased and have. ⁓
a change in hand and have to join the private equity group. But I would say, as you can probably tell, I felt pretty confident that this group, just given the stability and truly the culture of the group, I felt like the chance of that was going to be small. Now, could it happen? Yes. But honestly, I think they would still speak with me and have part. So I would have some say as to if we were to ever sell in private equity.
⁓ And I think it's a lot about like choosing the right person, right? So I always joke that the bar was set real low and they chose to bring me on as a practice because they're also incredible doctors. But I think like we really put a lot of effort into who we hire at our practice and that goes for the docs as well as like nursing and everyone we work with because we want to create and continue to create this culture where we like practice as a group. all have.
very similar values and continue to work together as a team to take care of our patients. And so I think moving forward, even though it's gonna be lovely to expand our group and take on new doctors, I think we're gonna probably look for that same type of core values of people who are wanting to join and put efforts towards our big ultimate goal.
Griffin Jones (53:14)
Meaghan, what type of personality would not be a good fit for your group?
Dr. Meaghan Bowling (53:23)
Can I say Dr. Myers first? No, I'm just kidding.
Dr. Lauren Johnson (53:25)
Hahahaha
Dr. Monica Schointuch (53:26)
That's so funny.
Dr. Lauren Johnson (53:27)
⁓
Dr. Bill Meyer (53:28)
Not to get any better.
Dr. Monica Schointuch (53:28)
If I listen to my voice...
Griffin Jones (53:29)
I said it up so you didn't have to name him.
Dr. Monica Schointuch (53:33)
my gosh.
Dr. Meaghan Bowling (53:35)
think definitely somebody who's kind of out for their own, someone who doesn't want to ⁓ kind of, you know, go with the, not go with the flow, but, you know, we all want to practice similarly. So we all can, we can all choose our own protocols, but overall we practice very similarly. We want someone who's going to fall into that. ⁓
that kind of protocol where they are able to kind of go with evidence-based medicine and go with what is best for the practice, what is best for our patients. ⁓ We don't want someone who's kind of out who wants to do their own thing who
also doesn't share the values of kindness and respect of nurses and doctors and embryologists. I we are definitely very much a family here. So ⁓ someone who ⁓ just really cares about their patients and wants to do the right thing, I think, is what we're looking for and not ⁓ someone who is more kind of out for themselves.
Dr. Monica Schointuch (54:49)
think what's really funny is we all have very different personalities. be clear, we're all very different. But I think it's like in such a beautiful way because similarly, like with patients, it's almost a personality match. Dr. Park was saying, like, we really truly do love to get to know our patients and kind of walk them through this process and this journey, like, hand in hand. But
Dr. Lauren Johnson (54:54)
You
Dr. Monica Schointuch (55:15)
has, I'm sure many of us has experienced, like there are sometimes like mismatches of personality of the doc and the patient. And that's okay at our practice because all of us are so different that normally they'll find a different doc with a different personality that works great for them. ⁓ But I agree with Dr. Bowling. I think it's like we all have that same like teamwork in mind at the core of our personalities, which is why it like blends so well.
Griffin Jones (55:42)
Who's gonna take over as the Chop Buster now that Bill's gone? Are ⁓ one of you gonna fill that role or are you gonna look for a fellow with a Don Rickles sense of humor?
Dr. Monica Schointuch (55:45)
I know, not me.
Dr. Lauren Johnson (55:55)
Dr. Meyer is irreplaceable.
Dr. Monica Schointuch (55:57)
We're
Dr. John Park (55:57)
Yeah.
Dr. Monica Schointuch (55:57)
a big mom. You'll be so missed.
Dr. Meaghan Bowling (55:59)
true. ⁓
Griffin Jones (56:01)
You all have been so much fun. thought that having five docs on was a logistically terrible idea, but a great content idea, and it was. And so I'd love to have you all back on or cover what you're up to in other ways. Thank all of you for coming on the show.
Dr. Bill Meyer (56:18)
Thanks, Griffin.
Dr. Lauren Johnson (56:19)
Thank you for having us.
Dr. Meaghan Bowling (56:19)
Thank you.
Dr. John Park (56:20)
Thank you so much, Griffin.
