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Entering the fertility space outside of owning a clinic is challenging. Entering the space as a tech company, well, that’s a whole other story. On this episode of Inside Reproductive Health, Griffin spoke with Jeff Issner and Taylor Stein, co-founders of EngagedMD. Together, they developed software that helps to educate patients and provide informed consent in clinics across the country. They share the story of how they got started in the fertility space, from idea to execution, without any commercial debt.
Jeff and Taylor also talk about how they got doctors and clinics on board before their software was even fully developed. Plus, they discuss the ever-challenging hiring process and what they do to make sure they are getting the best people on board.
Learn more about Jeff and Taylor and EngagedMD.
Other episodes mentioned:
Episode 36, Michael Levy
To get started on a marketing plan for your company, complete the Goal and Competitive Diagnostic at FertilityBridge.com.
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Welcome to Inside Reproductive Health, the shoptalk of the fertility field. Here, you'll hear authentic and unscripted conversations about practice management, patient relations, and business development from the most forward-thinking experts in our field.
Wall Street and Silicon Valley both want your patients, but there is a plan if you're willing to take action. Visit fertilitybridge.com to learn about the first piece of building a Fertility Marketing System--The Goal and Competitive Diagnostic. Now, here's the founder of Fertility Bridge and the host of Inside Reproductive Health, Griffin Jones.
GRIFFIN JONES 0:53
Today on Inside Reproductive Health, I'm joined by Taylor Stein and Jeff Issner, who started EngagedMD in 2014 after learning about the challenges that fertility patients, physicians, and staff face in the informed consent process. Both of them studied engineering at the University of Michigan and then met working together at Capital One Financial. Over the past five years, the EngagedMD platform has been rolled out to over 400 reproductive endocrinologists, educating and consenting one in every three fertility patients in the United States. They're also really big fans of the show! So I'm very happy to have on my good friends, Jeff and Taylor, Mr. Stein, Mr. Isssner, welcome to Inside Reproductive Health.
JEFF ISSNER 1:35
Thank you so much for having us today. We're huge fans. You know how much our team loves the podcast. So, so happy to be here.
JONES 1:42
Well, now I'm pissed off that I invited you on to the show because reading your bio, how much faster you have grown in the last five years and we more or less entered the space around the same time, and you've done so much more than I have and now I'm envious and I don't want to have you on the program anymore.
TAYLOR STEIN 2:00
That's not true. We don't even have a podcast.
JONES 2:04
Well, let's talk a little bit about how you got into the field because I don't--I think I knew that you went to college, but you didn't meet there is that--did you not meet until after college?
STEIN 2:17
Yes. So University of Michigan is a big place, even if you're even if you're both in the same engineering department. And we happened to be both moving to a new city, Richmond, Virginia that we had never lived in before and so it was through mutual friends at the University of Michigan that we did get connected, so there is that connection there. But yeah, we didn't we didn't actually meet until afterwards in Richmond.
JONES 2:42
So those four years--those glory of undergrad--they were spent totally in parallel without having overlap with each other?
ISSNER 2:50
I’m sure we passed at some point, but it was--Taylor was actually the first person I met when I moved south from Michigan. So total luck! He was the first guy and that was I moved to Richmond, we became really great friends, actually were roommates for a little while before all EngagedMD came together.
STEIN 3:07
And we're just spending too much time in the library studying at schools to have met.
JONES 3:12
So you moved to Richmond both for the Capital One gig?
ISSNER 3:17
That's correct.
JONES 3:18
Yeah. So here we are in the fertility space in healthcare, we hear engineering with the majors at University of Michigan and then here Capital One and think, financial, what are engineers doing at Capital One Financial?
STEIN 3:34
So I was actually in finance. So they have a program for people out of undergrad to learn all aspects of corporate finance. So that's what I did. And then I had in sort of an interesting role doing risk management. This was after the financial crisis, and then banks had new responsibilities to forecast and try to mitigate risk and so on. I was on a team that was doing that.
ISSNER 4:02
And similar story, so I actually studied mechanical engineering and as I was graduating, had the realization that I have no desire to actually use that degree and practice into my career. So kind of had a moment of what do I do next? Always loved IT and building things then I kind of luckily stumbled upon this job at Capital One at a similar program where they teach you all about information technology, develop that skill set. So I worked on their customer acquisition side of the house for a little bit, and then fell into the world of post-2008 crisis where we're putting in all these regulations and then eventually, a lot of consolidation happened in the industry with the companies that weren’t doing so hot after the crisis. So I was working on the integration side of the M&A team making sure that all of these credit card portfolios and banking portfolios came together nice and smoothly.
JONES 4:58
I want to go down this rabbit hole for a second because it interests me. Did you both graduate in ‘07?
STEIN 5:04
‘09
ISSNER 5:05
‘09
JONES 5:06
Okay, so you're graduating right after the recession had hit, so you're graduating like right into the thick of the recession. I graduated in ‘07 when things were quiet a little bit--very much how they feel now--like things were good, but it just felt like there was an eerie calm. And then of course, late 2008 the recession happens, you're graduating in the thick of it, it is already been laid on. I really have opinions about how that formed my career. Do you guys have--do you reflect ever about the uniqueness of starting your career during the recession? Does it even doesn't even play in at all? Do you think it's just a bygone period? Or do you ever reflect on it?
STEIN 5:50
No, no, I definitely think it makes a big difference. And there's actually a lot of research that shows that actually starting your career in recession impacts your entire career, including even the earning power, because so much of your sort of career trajectory can be traced back to those first jobs. I mean, it's not true for everyone on an individual level, but if you look at a cohort in the aggregate, you can see real effects from that stuff. But yeah, I think when it comes to an individual, you can be informed by it, but people have such different things going on that, that it probably affects different people in different ways.
ISSNER 6:32
Yeah. I mean, I look at it from a slightly different perspective. I think the job market of course, was thin in 2008, so I was much more open to exploring many different avenues. And I look at the pathway that took me from engineering into IT into learning more about finance and business and of course, meeting Taylor and the team that started EngagedMD. So it was really, you know, was like this funny sequence of events that are kind of built on each other and all impact each other. And I think at the end of the day, I was really lucky that all those events came together. I’m so happy with what we've done together.
JONES 7:10
I was happy to start my career that way because it really teaches you to work without fluff. And it teaches you to not take things for granted and it certainly taught me not to slow down. I remember seeing this--so I'm in radio advertising and sales at the time. I'm 22 or 23 years old, in a commission-only sales position calling on business owners. And I watched them freeze up. I watched a lot of people just get really quiet and a lot of them went out of business because of that, and I ramped up my activity. The plus side was that a lot of other sales people were being quiet, too, because they were afraid to call their clients and they were afraid to call new prospects and I went all in in activity and ‘09 wasn't my best year, but I made a decent living for that age. And then I came out of the recession really strong and my clients who were active during that time came out much stronger. And I've been thinking about the next one ever since. And so the reason I'm interested in going down this rabbit hole partly is because I want people listening to be thinking about what they're going to do if instead of growing at 10-15%, the field is flat at .5, 1.5 for a couple years and where are they going to make that up if the insurance companies are still tightening them further, and if they're not gaining market share from their competitors? I just found it so informative. Maybe that comes back in our conversation, but I'm still interested in how does fertility happen at this point? Do you see a need at the marketplace? I know Michael Levy is somewhere in this story, but how does that--how do you come to this field?
STEIN 9:02
So, just going back to your previous point real quick, and then I’ll get into how we got started in fertility. It's actually something I think about a lot as well. And just going back to our experience at Capital One and thinking about what do you do in the good times to prepare for the bad.?So Capital One was in a great position during the recession and the reason was because they were initially financing all of their loans through the capital markets, which means that you had to basically buy money and then lend that money. But during the good times, they saw that as a ris and they bought Chevy Chase Bank and some other assets that gave them access to cheaper and more stable cash. So it was through that acquisition and stabilizing their business that they were able to really weather the recession better than their competitors. And then because their competitors were in a bad position, they were able to take advantage of their balance sheet to then acquire those portfolios. So that was a huge driver of their ability to succeed and grow in the recession. So just doing the smart things to sort of shore up your business and the good times can have a huge impact in the bad times.
JONES 10:26
In terms of market share recession to the data that you were referencing, there's also really good McGraw-Hill data on different recessions and the ‘01 recession the ‘08-’09 recession, the one in the 80s and it really is the best time to advance market share. And I'm kind of excited about it frankly because of the talent pool. I don't know if you guys are having this problem, but this is really my first--the last couple years have been my first time as a hiring manager, and every business owner says that finding good people is the hardest part. But boy howdy, is it! And to find really good people, I found you really have to recruit them and it would maybe be nice if there were some overqualified people in the the job pool that just made the acquisition of talent a little bit easier. But I'm looking forward to that.
ISSNER 11:29
That's definitely the hardest part of growing a company is finding the right people, the right culture, that are really in it with the same mindset, the same goals in mind. That's been absolutely paramount to our success. And it's such a challenging thing to get really great people and to keep them engaged and all part of this great team.
JONES 11:51
So this great team started with what idea? With either what idea or what opportunity, what conversation--what was the genesis?
STEIN 12:02
So I am from the--to your other other question--I'm from the same area that Shady Grove is headquartered and so know Dr. Levy from that community. And the original idea for EngagedMD was his idea. And he basically, you know, he's a serial entrepreneur himself. He's got great ideas all the time, he's got his finger on the pulse of what's going on and he understands what it's like to face the challenges of a large fertility organization, sometimes they're the same, but sometimes they can be different from a smaller one. And so he was noticing these challenges of patient education, informed consent, not only from an operational point of view, from an experience point of view with his patients, and also from a risk management point of view. It's really difficult to do 100% of what you need to do in the informed consent process with every single patient. And when you've got a large organization with many, many physicians and many, many care teams, how can you be sure that you know someone's not having a bad day, or someone forgets something, or somebody’s rushed? And from a risk management point of view, that's where you have to worry about because even if you do it right, most of the time, it's those times where you don't do it right that's the problem. So the idea was his. I knew him through the community. What I studied in school was engineering, but it was computer science engineering. So I've been doing software, I started programming when I was like eight or nine years old, and I thought I wanted to be a programmer my whole life until actually I left college and said, maybe not. And so just through those things, we sort of got to going back and forth and that's how we decided to start the company. And then was thinking about, alright, what do we need to actually make this happen? Felt that it was really about important to--there were some things that as a, you know, that I couldn't do myself, and I know my own deficiencies. And I think kudos to you for being a solopreneur. But there's a lot of challenges that go along with that. And so I recruited Jeff!
JONES 14:19
I’m looking forward to playing this grass is greener on the other side game with you guys, like, of comparing and contrasting the benefits and the pros and cons of solopreneur and partnership. But so, you know, Dr. Levy, through acquaintance he has this idea, you have some expertise, and then you're bringing this to Jeff, how and when?
STEIN 14:43
Yeah, so we initially were going back and forth on the idea for a couple years and it wasn't really going anywhere. And I was actually headed off to business school. Jeff was doing software, like, leading software project teams at Capital One--
JONES 14:59
You were going to get your MBA.
STEIN 14:58
And if we were going to go anywhere, we’ve got to get Jeff involved. As soon as Jeff got involved, that's when things really kick started and we really started making moves in 2014.
ISSNER 15:07
And I remember the dinner so precisely. We were in Austin, Texas over dinner, both of our now-wives were there and started batting this idea around and the team came together. And from there, we ran fast. We raised a little bit of capital to get off the ground and five, six years later--
STEIN 15:25
Yeah, basically it was an idea and then when Jeff joined it, that's when it started to become a company.
JONES 15:32
So then, did you end up going to business school, Taylor, did you get your MBA?
STEIN 14:38
I did. Yeah, in Texas.
JONES 14:41
And now you're getting your real MBA, right? You got the paper and now you're getting the real thrown to the wolves with being in the company. So is Dr. Levy, a silent partner?
STEIN 15:55
He's very active in terms of, you know, advising. We produce a lot of education. content, he's very active in that. So now I mean, we're collaborating with him and in fact, a lot of physicians in the development of what we do all the time.
ISSNER 16:13
He's definitely a mentor to both of us. And actually speaking on behalf of your father, as well--Taylor's dad is a serial entrepreneur and is also a mentor to both of us. And it's just--I mean, it really makes all the difference. I don't think we would have anywhere close to the level of success we've had without the right mentors in place. And we've got a lot of them that are pitching in in a lot of different angles and a great advisory team, but Dr. Levy and Taylor’s dad really stick out they're just amazing mentors that have made our first true entrepreneurial experience successful.
JONES 16:46
Yeah, I mean, it sounds like how a lot of entrepreneurs would have an ideal case and that there's an established, seasoned, experienced person that can help get it off the ground, make some connections, maybe invest, and then two really young, talented people that can come on and execute and build and add their own vision. I don't think it often works out like that, but I think a lot of people, if they could dream up a situation, think like, Oh, that would be really cool to do! I want to talk a little bit about how you're able to execute it. Jeff, you mentioned that you raised some capital in the beginning, what channels did you use?
ISSNER 17:26
Yeah, so actually, Taylor I’ll let you speak to the fundraising approach that we've taken so far.
STEIN 17:32
Yeah. I mean, one of the nice things was, you know, some people with a lot of foresight in the field saw the same problem and they were wanting to get involved. So we actually, other than, like friends and family stuff, we have raised money from clients, potential clients, that kind of thing. So we have--it's a lot of just small people who kicked in some money--not small people, small investors. So we don't have any, like institutional money or anything like that. It's just people in the field that we're looking to solve a problem.
ISSNER 18:07
And it was, it was one of the coolest things once we started launching this platform, hearing all these people that said, Okay, I'll try this out, I'll do a little pilot, and then coming back and say, Wow, this really works. I want it. How can I get involved? That was when we went back to take the company to the next level, we went back to these doctors and administrators that said, This is a phenomenal idea. I want to be a part of it, I want to contribute ideas, and they helped raise that extra amount.
JONES 18:34
You're having potential and current customers invest, but this investment is different than simply, you know, getting pre-paid for example. You're not just doing pre-selling that there they are investing in the company.
STEIN 18:47
Correct.
JONES 18:48
So I want to explore this and explore this way of raising capital and of building the company at probably a faster speed and having partners versus the way I did it. And we can go through the pros and cons of each of the ways that we did things. So the benefit to having investor money--so you got money, you got some capital. The reason why I didn't do it in the beginning and still probably won't for some time, or at least until the business is quite different, is because it really puts the clock on, I think, and when you have people giving you money, you've got to deliver. And that's true for your customers as well. So I already have to worry about that with my customers. But at that level, I've always felt like no matter what I sell, I know what I'm selling, and I'm going to manage the expectation to where I'm going to make sure that I deliver what it is that we're selling. In the beginning, it meant me taking almost no profit. And you know, for the first year, I lived--I moved back in with my parents, and that's not fun to do as a 30 year old entrepreneur. Nobody's putting you on the cover of INC magazine at that phase of the company. But it did allow me to do--pretty much I could always return the investment because even if I had been off slightly more than I could chew, it's not like I was going out and buying a Mercedes with it. I put that into hiring somebody and bringing on some other established firm that could deliver and always made sure that that was delivered. That's harder with investor money because you have to return their cash. So what was that like for you all?
STEIN 20:38
Yeah, so I think it's a question like, how do you finance business is there's pros and cons to all different models and some models work better for certain situations than others. So the first thing that I would call out that might be a difference here is that we have different capital requirements, because we had to build and support a software platform. And that's expensive. And you also have to pay--you have to spend that money well in advance of when you are going to be getting revenue for it. And so you have to finance that, like there's just no getting around it.
JONES 21:19
Have you ever read Dane Maxwell or if you guys have never heard of him, he had an online, sort of like an online academy for software entrepreneurs and what he posited was that you can build software by having all of your customers prepay and it wasn't successful. I think--I don't think he still does that anymore, but he posited that you can become a software entrepreneur just by having your current customers or you pre-sell. You have those customers pay for an MVP, you iterate, etc. And I don't think he does that anymore.
STEIN 21:57
Well, I would argue that maybe you can do that in some realms, but healthcare--
ISSNER 22:06
Healthcare has such a high standard of what you're putting in place for a good reason.
STEIN 22:08
Yeah.
ISSNER 22:09
But you're dealing with sensitive information. We're talking about patient consent forms. You've got to have your platform secure, strong, scalable, ready to go from day one, especially when you're launching with the Shady Groves and these big groups.
JONES 22:24
Yeah. So you've got the capital requirements, and of course, you need capital to pay for those. But what does that do with the pressure of the timeline of when we started having to return people's money and how does revenue catch up?
ISSNER 22:43
I think pressure is a good thing. It's definitely good for me. I think it's the same for Taylor, when you know, you've got your own career on the line, but you also have somebody else's money, somebody else's pressure on you, that helps drive things. I think, overall, we took a relatively conservative approach. We weren't raising mega millions from VCs or anything like some institutional investors, but I thought it was a really helpful thing to keep us engaged, keep us in line, have timelines of the goals that we're trying to achieve, and then going back to the well when it makes sense.
JONES 23:17
Did you also get commercial loans from a bank?
STEIN 23:21
Nope.
ISSNER 23:22
No, we did not.
STEIN 23:23
No, that was it.
JONES 23:24
Why did you choose investments exclusively over borrowing? What was that conversation like?
STEIN 23:31
You mean equity versus debt?
JONES 23:33
Yeah.
STEIN 23:34
So I think if we were to want to do a debt from a bank--first of all, I don't think banks are typically in that market to invest in really speculative software startups--but even if they were we'd have to put up personal guarantees for that because a company with no assets and no revenue is going to have a lot of--it's going to have a hard time raising debt financing without personal guarantees. And I think you want to be able to have a stable financing position so that you can worry about the operations of your business. I think, if you don't have other options, then you know, maybe for some people, that's the right way to go about it, but I don’t think that I feel if you can if you raise equity.
ISSNER 24:25
And having the right people with skin in the game is huge. They can advise on how to enter the fertility market, actually treat patient education set of problems. When you know, Taylor and I went into a clinic and we're able to go through the actual process of being patients and understand what they're dealing with, and get the advice from all these different people invested who are part of this field. I think that's a huge part of why we are able to understand the problems and to really address the core problems. I think we come from a banking engineering background, it's going to be really difficult to enter this market without the right partners and the right advisors.
JONES 25:04
Yeah, and that might seem like nuance, but it's not a subtle difference, is it, between getting equity from private equity firms that have big portfolios and are located in New York or venture capital firms in the Bay--you're getting investment from people who are also your ideal customer.
STEIN 25:25
Definitely. It's a huge part of what we've done. I mean, for the most part, it's been very organic. So of course, there’s no like if you’re an investor, you have to use the platform, but it's people who see the vision and want to be a part of it. So we've been very fortunate with our investing group.
JONES 25:41
So not being in that form of financing for my own company, I always wondered at what point did say, okay, now we're not looking to bring on any more investors. I mean, some companies, even the largest in the economy in the tech sphere, at least right now, they just keep getting investors and so, at what point is--and as entrepreneurs, we always feel like, we could do this. We could grow here. And I could just see how certain companies would keep going down. How do you decide, okay, we're good on how much equity we've given away at this point. Now it's time to shore this revenue line up or shore up our own position before we bring anybody else on. How do you make those decisions?
STEIN 26:28
Yeah, I always say you come up with a plan first, and then you figure out what your financing needs are for the plan. So we're constantly reevaluating, like every couple months, we rerun our models, we modify those, we try to project future cash flows and cash needs. And then based on that, we decide what our financing needs are. I think a lot of the companies that you see that are really out there like Uber for example, they are in winner-take-all markets and so strategically, what they want to do is they want to be the winner. And they know that if they can beat out all the competition, they will have an amazing monopolistic business that will be super profitable for them. And if they lose that, they're going to lose everything. And so for them, it makes sense to do everything they can to be that winner. And if that means raising a lot of money and selling a lot of equity, then that's just what they have to do and they know what game they're playing. I don't think that that's the case for all businesses, and it’s obviously a very risky strategy as well, and it's something that really only makes sense if you have an enormous market like Uber has. So yeah, so for us, we kind of use just more basic strategies, just trying to understand what we think we can do, what our goals are, and then looking at our financials to determine what our financing needs are.
ISSNER 27:58
Yeah, there's no one size fits all. I think you can see in the fertility space see multiple different models. Some companies that have raised a ton of money taking more of a traditional Silicon Valley approach, I’ll call it, some companies that have not. And we've seen different levels of success with those, some that make it, some that don't. So I think we've taken a middle of the fairway approach in terms of capital raise, we set a goal, we've achieved our goals so far, and we see a really good opportunity group behind us that's going to support it those opportunities.
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JONES 30:23
So in tech, it's common to have co-founders, in the medical field, it's very common to have partners, in client services, it's common, but we also have a saying which is you either have a bad partner or you are the bad partner. And I have seen firms and companies of all sorts crumble apart from partnerships. I've also seen ones that seem really successful and there are times where I think boy, I really wish I had someone who had a complimentary skill set, one that is different from mine that shared my values, but had a different talents set that was as invested in this as mine. That would be really useful. And so I do sometimes have that grass is greener, envy, but I also think like there are times where I like being the dictator. And I like saying that you know what, I get to decide! That's the beauty of free enterprise, that I just get to build this company to be what I want it to be. And so how do you two set the boundaries, the rules, get on board with the same vision.
ISSNER 31:38
It’s constantly changing. I think you said something really important--shared values is huge. Taylor and I were really good friends before we started this company and we’ve been at this for six years now and we spend way more time with each other than we do with our wives, so the fact that we haven't gotten at each other's throat yet is really amazing, but I think we respect each other, but we do complement each other well. When we--really until fairly recently--we kind of made shared decisions on everything. We both oversaw the company, we came together and we were just kind of do everything together. As we've grown, we've realized the need that we have to break up the company to some extent and have our own departments, oversee our own areas, of course, consult with each other, bounce ideas off each other, and that's where I think having a good code of honor with shared values goes a really long way. When we're talking, even when we're walking the dog, it's constantly, What about this idea? How do we approach this problem? Here's something I'm dealing with, what would you do in this situation? And I think that really has made us stronger, just having complementary skill sets, shared values, and really it’s just open dialogue where we respect one another's opinions.
JONES 32:52
I have talked on the show about EOS before--have you ever read about the entrepreneurial operating system, EOS? Are you guys familiar with that at all? There's a book called Traction another one called Rocket Fuel by Gino Wickman. So we've sort of jerry rig built our company on EOS and now that we're getting bigger and more mature, we're talking to implementers about proper implementation. But EOS posits that it takes two people to run a company and they don't necessarily have to be Equity Partners, but it posits that organizations from 10 to 200 people are best run by two different people: one being the visionary, one being the integrator. And before I delineate what those are and where I see myself and where I'm looking to go with my own company, do you two sort of identify in either of those spaces? Or how would you describe your skill sets as this is what I know that I'm good at and what I'm weaker at, and this is what the other is good at and weaker at?
STEIN 33:58
It's a good question. I think neither of us fully falls into one bucket or the other. And I think one of the things that--
JONES 34:05
See, that scares me! One of the things I'm most scared about of having a partner is someone who is too much of a visionary and less of an integrator and we just fight and don't have--I mean, and you guys aren't doing that, so there must be something that complements each other.
ISSNER 34:26
I think that we trade places over time. Sometimes Taylor is the visionary and sees the forest through the trees and I'm just so far in the weeds that sometimes I think Taylor’s really in the analysis and stuck in the data, and it's like, wait, hold on, look at all this other stuff that we can do. So it's interesting. I think it’s the size of the company, the place of the company, evolves and it complements each other really well. I think we're able to pull each other out of their respective ruts when one of us is too pie in the sky, we're able to kind of balance each other out. And it is interesting, I mean, at the beginning of the company, I would definitely say you were a visionary and I was--I came in to execute, execute, execute, but I really do feel like that's shifted over time back and forth.
STEIN 35:09
Yeah, so where I think it--because I do agree with that paradigm, but I think that, at least with us, one of the reasons we work well together is that one person’s not always playing that position. But I think in any scenario, we probably do have one person on one side, one person on the other side, so I do think the pattern kind of exists but it sort of shifts back and forth. And I also do think that in a partnership, it's so important to fight for your ideas, but to not feel slighted if your idea’s not the one that you go with. You got to step up and step back. It can be so consensus driven that nothing ever gets done like unless we all agree on the same exact thing and we're not going to do nothing, because doing nothing is this is a decision as well. So someone's got to, like, at some point take the reins on any one decision, say like, we're doing this and like, the other person that has a responsibility to say like, seems like you got this under control. I don't have any, maybe I have some minor concerns, but I can get on board with this. And you’ve both got to be able to do that. If you get too ego driven about it, or if you feel like you're not being heard or something like that, that's a thing we get into trouble.
JONES 36:26
I can see how your partnership is really working based on that dynamic. And it makes sense how you trade places sometimes--I can see that in both of your answers and just from knowing you a little bit. For myself, EOS posits that the visionary is the lead on company culture, is the lead on the big sales, the lead with the key client relationships at the highest level and with vendors, and is the one that has the ideas that determine the future value of the company, that keeps the company from being stagnant, and and allows them to innovate. The integrator is the person that manages people, that implements systems and builds processes, holds people accountable, and implements the vision of the visionary and integrates the core functions of the business at the leadership level. And so I think most people can guess which one of those I fall into and Fertility Bridge has grown at the pace that it has because I am still in both seats. And this year, I'm hiring an Operations Director, so it might not be an Integrator level, but the time where Fertility Bridge really takes off is I think when I'm when I'm in that visionary seat almost exclusively, and that is the downside to not having any investors or even--I never even took out a commercial loan. So my business has been entirely funded from sell, deliver, hire, sell, deliver hire. And the con of that is that it's slow and that it is frustrating in knowing that, you know, you can see the things that you need, but you know it's going to be another year and a half before you can afford it and that's where I think the entrepreneurial sliding scale of where am I on the risk tolerance. Now, once things start to be clear, I'm comfortable making decisions sooner and earlier. For me the first two years, maybe three, were just figuring out what I even wanted my firm to be and what direction I wanted to go in. And so now that I can see it, I see okay, here's the next needs. But at this point, I don't think money--an injection of capital wouldn't really help me with my challenges at this point. The only thing I think it could do is help me overpay for people so that I could get people sooner, but that's still to me seems like a fundamental business issue. And so for you guys, I’m wondering--does money sometimes mask things--I guess I want to probe a little bit more of the pros and cons--does money sometimes mask fundamental concerns that the business needs to address in order to be sustainable? But I could also see scenarios where it solves them. So talk about the role of money in that instance.
ISSNER 39:42
Yeah, so maybe this will answer your question, maybe it will take us on a totally different tangent here. I think early on, we were very tight, very careful with our decisions in terms of hiring, in terms of spending. We didn't take out a ton of capital in the very beginning and I think it very much prohibited us. Whereas by being a little bit more loose and being a little bit more, you could call it risky, but I think it's actually normalized for a business like ours, we were able to reap the benefits so much. And I think it's all about the people that you're hiring at the end of the day, that's what's going to grow your team. So I think when we really opened up, figured out how do we delegate, how do we get great people to solve the problems that Taylor and I are not well suited to solve, but we need that support. We need somebody who can just be an expert at those things, that’s what really unleashed the business. And so, I'm still trying to push myself more into a little bit more risky, bringing the right people on in the right places, because those people are going to create a culture in your business. They're going to create the brand of your company with your customers. It's really everything in terms of the stage that we're at. You've got to have the right people because you can't just be an entrepreneur doing it just by yourself. You've got to have a support group.
JONES 41:02
I would argue what makes an entrepreneur, an entrepreneur? If not a singularly exclusive definition, at least a tenant that's a part of it, is the hiring of other people. I don't consider solopreneurs to be entrepreneurs for that reason. I didn't really feel like an entrepreneur until I had a payroll. And I definitely messed up my first hire. I sort of messed up my second hire, though, I do think that it was a person that I needed at that time, even if it was just to get to the next level and part ways amicably and make sure that person gets to a good place, too. I feel like I'm much better at it now, but I'm still quite slow at it. What have you all learned? What were your first couple hires like and what have you learned and what's your process?
ISSNER 41:55
That’s a whole other podcast.
STEIN 41:58
So I think what we've learned is that it's super hard. And actually, the challenges have evolved as we've--we're still a really small company. We just hired our 11th person. And so our first ever hired was a great hire, she's still with the company, and she's doing really well. And she set the tone in terms of culture and for a lot of things that have evolved since then. We've had some good experiences. It is really difficult though because you have a need for somebody right now. But you really want to make sure that you hire the right people because the effects especially of those first hires are like, they don't go away. So you know that hire slow fire fast mantra, it's definitely easier said than done, but in our short experience here, I think it's for sure true. And then as we've had to hire more and more people, especially in skill sets and areas where we don't personally have experience, it's really difficult and you know, we try to put in place processes and ways to go do this so we can see a lot of candidates, evaluate them against each other, but we would be just lying if we said, like, we figured this out.
ISSNER 43:27
I do think that every single hire we make ,we learn more about how to hire properly. We definitely don't have it fully figured out. We've made our mistakes along the way as well.
JONES 43:36
You learn a lot about nuances in skill sets and personality, don't you? You know, you think that oh, this is the skill set I'm looking for and then you hire for it, and you're like--. Actually, the first time I hired a Project Manager, it was someone that was my Assistant and this person was great in the Assistant role. I’m thinking, oh, somebody that's a good admin would also be a good Project Manager, it's not the case. And I’ve thought, you know, a person that's a good Project Manager will be a good Operations Director. And that's not necessarily the case either. And a good Operations Director isn't isn't necessarily going to be a great COO. And so please go on. But you're starting to reference some of this, like, nuance that you're learning.
ISSNER 44:18
Yeah, I think we actually got really lucky with our first hire. And TK, major shout out to Taylor! She has just been such a rock star from day one. And she was a couple of years out of college when we hired her, we didn't know what we were doing when we're hiring, but it felt like a really good culture fit. And above all--I know I reference culture a couple of times during this chat--culture is such an important thing. It keeps everybody happy, keeps everybody engaged, it keeps people aligned at the same mission. And I think Taylor came--Taylor, the hire that I'm referring to--she came in with the right attitude, set the right culture, set the right norms and I think that's had an influence on all the hiring that we've done. So, so much of it came down to like, okay, this feels right in the gut. And I think it's really paid off. But we're constantly learning every hire, we're constantly learning, what can we do differently? What types of questions can we ask? How do you really think these kind of minor interactions in the grand scheme of things, figure out who a person is what drives them?
JONES 45:22
And Taylor, you mentioned the adage of hire slow fire fast, it is sage business advice. You also talked about it in the beginning, you grew slower, you took less money, you are more cautious. I think it is possible to hire too slow as well. Do you?
STEIN 45:44
Yeah, absolutely. I mean, also, you don't--when you’re hiring people, you don't get that many interactions with them. Even if you have a really robust hiring process. I mean, it's not like you really, really know that person. And on top of that, when you're building a company for the first time, a lot of times you don't even know exactly what you need.
JONES 46:13
That's the problem. I think that's the real big problem.
TAYLOR 46:16
So I think to Jeff's point before about like hiring on some core attributes that you know you want, so hiring on culture, hiring somebody that is passionate about your business--like if they really believe in your business, then they're going to spend the time to learn and to grow and all that. Hire someone that's sort of aligned with your vision, like--you know, for me, if someone is interviewing because they don't like their existing job, that is a red flag to me. I want people who want to join my company because they really like my company and they really like the fertility space, and they really have a passion for the problems, like that is beyond like how good at Excel are you. So there's some core fundamental stuff that some It can be really difficult, but I've got some questions that I know I ask every time to people and I think if you get the core stuff, right, you're probably going to be in pretty good shape and then if you figure out the rest, then you can tell me. I mean,
ISSNER 47:13
I mean, I think having smart driven good people that are willing to learn--and we've had a number of instances where people have maybe not had a ton of experience in the particular skill set, but came on board and just wanted to learn and just want to be a part of the mission and be a part of the growth and have really just knocked it out the park.
JONES 47:35
And what you referenced, Taylor was that having those people that are so passionate about the cause, and the company--I think you brought that up, too, Jeff--that is that's critical and shout out to Megan and Ashley on my team because that's them. They're so passionate about the infertility community and our mission as a company that I just knew that they were going to be successful and get over whatever learning curve because they wanted to. They really wanted to be--very intrinsically motivated. And so I love that. And then there is also, I think, a value in--I once heard another firm owner said, f-hiring junior, only hire senior talent. And I wouldn't take that as extreme to be exclusive, but I do see the wisdom and I wonder if you found that also. That you're hiring, sometimes junior people, but then you hire those senior people and it is a difference in, I guess, their speed to contribution?
TAYLOR 48:37
That's a great question. I don't know that we have enough information at this point to really know. And I would also guess that you really have to know what you're looking for, to make good senior hires because a lot of senior people, I think, one of the reasons you're bringing them on your team is because they have some specific experience where like they've been in the fertility space for 20 years and they know everybody, or something like that. But along with that is their way of doing things. And if we look--one of the challenges that we've had is that the fertility field is not a big field. And on top of that, there's very little software in the fertility field. And what software there is, it's not like we've seen other examples of great software and said, Oh, we really want to be like that. It's actually quite the opposite. So if we wanted somebody who is really senior, let's say someone to sell software in fertility, who is there to find? There isn't anybody. So we could get a senior person that knows selling software, but doesn't know anything about fertility. Or a senior person knows everything about fertility, but doesn't know anything about software. It's a real challenge. There is no, like, perfect person. So sometimes we've had a lot of success in just finding somebody who has less experience and is willing to learn and try new things. I'd imagine that if you can find that person with a lot of experience, but also could figure out how to apply that to your specific use case and was really active about trying to get out of their comfort zone, that would be the ideal. That's my guess, but they're also much more expensive, so there's a big risk factor there. So yeah, I guess with all things, it's kind of a balance. I don't know of any hard and fast rules that I would say.
ISSNER 50:38
Yeah, we'll get back to you once you figure it out.
JONES 50:41
And I'll do the same. Maybe we'll do this annually! But I'd see your point, Taylor, that part of what you want is this established knowledge and experience, you want to bring that into your company, but you're also not building your company modeled off of anyone else. And I think about that when I want to hire an Operations Director there sometimes where it's like I would just like somebody that that just knows some of the fundamentals better, but at the same time many of the fundamentals I have, I don't want in my business at all. I have built my firm to be very different from other agencies. I am trying to build a world-class firm. I want to be walking around ASRM and have people talk about Fertility Bridge as a world-class firm. And that means not doing the same thing that everybody else is doing. So that's a good point about it is a bit difficult--more difficult--to hire senior talent if you're not trying to replicate what experience they've already proven.
ISSNER 51:43
And there's no patient education and informed consent software in the fertility space. So nobody's done this before. We want to be novel and not only our software, but our approach and our support and the staff and practice’s experience as well as the patient experience. So, really trying to reinvent things and I think it's healthy to have somebody who doesn't have built in mechanisms about this is the only way to think about it. We really, really pride ourselves on that.
JONES 52:11
Well, we've had an amazing conversation. It's already been a long episode, and we weren’t terribly tangential, we mainly stayed on the topics of financing and hiring. So I want to keep this coherent and can we do this--I'd love to have you guys back on to talk about EngagedMD’s role and what you see in the market in what you see in the future of automation and in software in our field. I'd like to talk about those market applications in a separate episode. Have you guys back on in the not too distant future, even maybe a couple weeks or just a couple months from when this episode airs. And why don't we have you guys conclude with just your thoughts and experience on breaking into a new field and how one does that? Or just your recap from financing and hiring, how one breaks in or your reflection on how it was for you?
ISSNER 53:09
Yeah, I think it's a little bit of a mixture of everything that we've talked about. So having good mentors and good partners, a little bit of luck in terms of timing and the market dynamics, and really, a lot of elbow grease, a lot of blood, sweat and tears. We worked really, really hard to break in and coming from outside of this circle, we were fortunate enough to have people who kind of reached out and welcomed us into the circle, but it's been a lot of hard work trying to truly understand what the problems are, who's facing them, what the different layers are, and putting together a solution that really addresses those problems specifically. I think it's really easy to have an idea and say, okay, I'll just go do it. But you've got to understand the nuance. You've got to understand the people, you've got to understand all of the different market dynamics. So, a little bit of luck, a little bit of skill, a lot of hard work, great mentors and partners.
STEIN 54:08
Yeah, I would totally agree. I mean, all those things like, you’ve got to work hard, you’ve got to put yourself out there, you've got to sort of be humble about what you know and what you don't know, you’ve got to be able to learn as quickly as possible. All those things are true, but the luck factor is crazy as well. I don't know that I had any like--there's probably a lot of repeatable stuff, but some of the some of the interesting experiences and things that were just--it's not like they were planned for anything. First of all, having, you know, really great mentors, as Jeff said, Dr. Levy,being right about so many things, and just being somebody who's so willing to be involved and having a great idea. Then also things like, at our first ever ASRM, I met Paco Arredondo from what was called RMA of Texas at the time, at one of the many great parties that’s at ASRM. He was so nice and so engaged and I was in business school at Texas, and he had an office in Austin and so he said, Come up--after ASRM, come on down and come meet the team, and those are people still today that we are engaged with all the time. And it's led to so many things. And, you know, other than just saying, I'm willing to go to this fertility party where I don't know a single person in this industry, I don't know, at that time, what they do, or how to talk to them or anything like that, like you got to put yourself there to be able to have those interactions, but like to meet great people like that. And then it's just such a great field with a lot of really interesting, smart people who are passionate about what they do and want to push things along. So it’s good!
ISSNER 55:45
I think we would all agree about this, we talked about how it's a smaller market and the challenges around that, but there's a really cool thing about it being a smaller, smaller market. It's a community.
JONES 55:55
It’s one big high school.
ISSNER 55:57
Yeah, when we go to these conferences, it's like you're seeing all of your friends. It’s so nice. So there's something really, really special about the fertility space. And we're really lucky to be a part of it. I think about the first question you asked is how did we get into this business? I mean, such lucky timing, things that happened where I ended up in Richmond, Virginia and that Taylor wisely started this business. It was just a sequence of really right place, right time, and a lot of energy and hard work that kind of got us where we are.
JONES 56:29
I wholeheartedly echo that it is a very special community of people in this field. And I look forward to talking about that more the next time we have you guys on. I gotta give a big shout out to the EngagedMD team because I know that your team listens to the podcast, and I really, really appreciate the support. So shout out to all the employees and team members at EngagedMD. I love you guys right back, and Taylor and Jeff will be back on the show. So Jeff Issner, Taylor Stein from EngagedMD, Thanks so much for coming on Inside Reproductive Health.
STEIN 57:03
Thank you. Thanks for having us.
ISSNER 57:04
It was a pleasure.
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You’ve been listening to the Inside Reproductive Health Podcast with Griffin Jones. If you're ready to take action to make sure that your practice drives beyond the revolutionary changes that are happening in our field and in society, visit fertiltybridge.com to begin the first piece of the Fertility Marketing System, the Goal and Competitive Diagnostic. Thank you for listening to Inside Reproductive Health.