This week on Inside Reproductive Health, Dr. Brian Levine and I discuss what it's like to launch a brand new center under the umbrella of a very large company in an extremely large market (New York City). We also chat about the pressures of launching a denovo clinic in a big market versus the pressures of starting a clinic as a satellite office.
Dr. Brian Levine is the founding partner and practice director of CCRM New York. He is board-certified in both reproductive endocrinology and infertility and obstetrics and gynecology. Brian Levine, M.D., leads the industry in normalizing open dialogue about infertility and educates prospective parents on a national level. He has been cited as one of the nation’s leading fertility experts in The New Yorker, New York Post, NBC, CNN, Avenue Magazine among others, and was honored with the Doctors of Distinction award in Westchester County.
From this episode you’ll learn:
New York market dynamics insights
The value of good mentors
Where technological advancements are happening
Why REI’s don’t get the training they need from school
Transcript
Griffin Jones: [00:00:52] Today I speak to Dr. Brian Levine from CCRM New York.
Before we get into the topic of what it's like to build a Denovo center within a very large group in an extremely large market. I want to give today's shout-out to Dr. Kenan Omurtag thought of Dr. Omurtag because I met him around the same time that I met Dr. Levine also did a piece of content with him early on when, in my tenure, in the field.
And so shout out to Kenan and hopefully, I get a text or an email that he got wind of this shout-out. Today's show with Dr. Levine is about what it's like to launch a brand new center under the umbrella of a very large company in an extremely large market. We talk about what that's like the pressures of that are like, versus the pressures of starting a clinic as a satellite office for someone else as an associate, for example, and we talk about the dynamics of the New York market. What CCRM is like. A little bit of background about Dr. Levine. He's the founding partner and practice director of CCRM New York. You may have seen him on New York Post, NBC, CNN, Avenue Magazine.
He gets around, I believe ASRM tech committee is where I may have originally met him. And so please enjoy today's episode with Dr. Brian Levine, one of the Castle Connolly, top docs from New York's super doctor ranking about what it's like to start a Denovo clinic within a large group, big market
Dr. Levine, Brian, welcome to Inside Reproductive Health.
Dr. Brian Levine: [00:02:32] Thank you Griffin for having me, I'm super excited to be here today.
Griffin Jones: [00:02:35] I almost said welcome back. But when I realized it, when my podcast producer brought to me a list of suggestions for topics, and we put you on there and I thought, oh yeah, we'll have Brian back.
You haven't been on the show. You were a guest author in the ultimate guide to fertility marketing, which we wrote five years ago, but this is your first time on this show. And I always; I guess I just always thought you were on Brian. So it's, we're overdue, but I'm glad that you're on the show right now.
And I want to talk about the situation that you've been in, in your career, which is starting a new practice in a very established group in a new market. So do you want to set us up with a little bit of background for that?
Dr. Brian Levine: [00:03:18] Sure. To help set the foundation for our conversation today, the theme that I think we should bring forward is a partnership.
Cause that's what this whole topic is really going to be about. And, starting a clinic and working with an established brand and helping, be part of a new of that brand. Now growing into something new and exciting the theme is partnership today and, I've been very fortunate.
For me, I think it was timing being in the right place at the right time. So I'm a New York guy, right? Like I literally have not left New York City since the summer of 2002, when I graduated college. I went to graduate school in New York City, I went to medical school in New York City.
I did my residency here. I did my fellowship here and truth be told. I always viewed myself as someone who was going to be part of that academic rigor. Like I always thought I was going to be at some hospital with some affiliated medical school teaching seeing patients mentoring, residents, and whatnot.
And there really was a turning point for me in fellowship. Where I had to make a decision. I had to make a decision of, do I want to go down this academic pathway and help train the next generation? Or do I want to start treating the current crop of patients that are having trouble achieving their goals and what really pushed the envelope for me was ASRM.
You and I were just talking a few minutes ago about conferences. And I remember going to these these meetings and seeing just the publications that were coming out of places like the Colorado Center for Reproductive Medicine or CCRM and saying to myself, oh my gosh, like you'd have a private practice that does research.
And that is actually moving the needle, improving patients. That's outside the confines of the academic models that I've grown up in. That I've been a part of. For really 11 years of my life.
Griffin Jones: [00:05:05] Why was that your conception at the time that research was for academic? You wouldn't expect to see an abstract or research from a private institution.
Why had that been established in your mind?
Dr. Brian Levine: [00:05:19] I think unfortunately that many of us are very jaded in medical school. We never learned about the business of medicine. I never learned about leadership and how to run a group or how to form a practice. And we also learn, unfortunately, either by osmosis, right?
No one ever says it, but they just infer it, that the private docs are out there for the wrong reason. And that it's the academic people that are going to move the needle forward. And I think it's a culture thing. Unfortunately, I think it's a culture of academic medicine and the training of young physicians.
And so to me, I was always jaded. I always just thought, like the only way you can make a difference in the world is to be part of this academic rigor and, become an assistant professor and strive to be associated and strive to be a full professor. And it just didn't jive with who I was as a person.
Right. I'm a geek. Deep down inside. I'm a big technology geek. I like data. I like technology. That's why I'm in this field to be quite frank. And what I saw was that the most innovation that was occurring, that real bench to bedside transition of taking a concept to an experiment, to a trial to a patient treatment paradigm was actually occurring in these private practices. And that's what intrigued me.
Griffin Jones: [00:06:32] Do any examples come to your mind when you think of those experiments and what was happening in the private realm that you weren't seeing in the academic realm?
Dr. Brian Levine: [00:06:44] Absolutely. I'll give you a great example of the great debate of our field, the genetic testing of embryos.
I will never forget one of the first American society for reproductive medicine, annual clinical meetings that I went to was, someone's standing up on stage with a soccer ball saying, if you take a biopsy of an embryo, you don't know if you're getting the black or the white, and you're going to judge an embryo by the specimen or the biopsy you get.
And then you had these other doctors standing up saying, look, I have a private practice in Las Vegas. And I can tell you just straight-up frozen embryo transfers versus fresh embryo transfers. There's a benefit to frozen. And if I can pick the right embryo that I'm putting back in that frozen setting, I can not only have an advantage based on the frozen.
I have an advantage on that embryo selection. And it was literally that debate about genetic testing, which by the way, What's in its infancy stages compared to where we are today, nine years later that really drove me towards the private side was the ability to have freedom of vendors, the ability to incorporate new technology the ability to incorporate new protocols and treatment plans without having to deal with the confines of the academic institutions that are very well established.
But, there are restrictions that are there
Griffin Jones: [00:07:58] That experiment and others, like it are what drove you to the private side. And I do want to talk about partnership. I want to unpack that some more, but first I want to be between partnership and being interested in the private side was an interest in where you are today, which is CCRM at the time. Maybe they were still in Denver, mostly.
Maybe this might've been the time that they were expanding into other markets. But talk to me about how you came to get CCRM on your radar.
Dr. Brian Levine: [00:08:30] Yeah. So I've been really fortunate throughout my entire training career. I'd say now professional career is to have good mentors, right? So everyone needs a good mentor.
When I was in medical school, it was Dr. Jamie Grifo at NYU. I finally remember skipping classes even to just go shadow him. I hate to go to the operating room as a first-year medical student to see him remove someone's diseased fallopian tubes, or remove fibroids or come in on a weekend to see him do an egg retrieval.
When I was in residency, people like Dr. Mark Sauer and Roger Lobo. Amazing mentors again, who were really pushing the envelope of reproductive endocrinology, and from Dr. Salaria, I learned about the whole world of donor oocytes and donor egg. And then of course in fellowship, I had Zev Rosenwaks who is an unbelievable mentor.
And, I'd say really one of the pioneers of the field, but when I was in fellowship there are certain names that just come up and be like these pioneers of our field that really are pushing the envelope over. And we kept talking a lot about Dr. Schoolcraft, Dr. Bill Schoolcraft at CCRM, who is the founder and the lead of that group, and how they were doing things differently.
We would talk quite often about the research they were doing about genetic testing, how they had an entire integrated genetic testing core. And it just piqued my interest. So it was at the Boston ASRM that October I'll never forget 2013 where I met him, I just went up to him and introduced myself briefly.
And I said, I just want to learn what you do because I keep hearing your name in a positive light and in a true mentor, mentee fashion. I think that's where he took an interest in my interest in CCRM and that's where I started learning more about what they were doing. I had no idea that they were ever-expanding.
When I went to go talk to him, even though I'm a Newark guy, I think part of me thought I could end up in Denver if I'm lucky enough to be there.
Griffin Jones: [00:10:28] I want to talk more about that expansion and I certainly want to get to the partnership, but your thoughts on mentorship really have me in a bit of the soliloquy here, which is, I think this is one of the challenges that many centers that are having difficulties recruiting fellows are facing what I get emails from fellows.
Brian, I'm a D biology student. I run a business development and client-services firm, but fellows will just ask me about where do they think I should go or who I should connect them with? And maybe it's because I'm completely fiduciary. I can just introduce them to anyone. But I also think that there is somewhat of a dearth of, it's not that there's a dearth of clinical mentors in the field or people willing to help.
I think that there's a certain scarcity of. Doctors that have a profile that's facing the fellows that they see, that they can reach out to in the same way that you just described Dr. Schoolcraft, that in and how you reached out to him at ASRM Boston. And that does have that. There's a handful of groups that are getting more than their fair share of younger doctors in terms of recruitment.
Yeah. Maybe just talk a little bit more about that because especially for, these midsize groups that now they're starting, maybe they had an associate and that associate left and didn't end up moving on to partner and they're having a little bit of a struggling with recruiting the next person to replace them.
I think that it comes with this profile of mentorship. So maybe you could unpack that a little bit more.
Dr. Brian Levine: [00:12:03] Yeah. No one can do it all. You can't work 365, you just can't. And if you are, you're probably not good at your job if you're working 365 because either you're not giving yourself enough time to Recoil and, build yourself back up and build up those reserves again.
Or if you're burning yourself too thin, it might be that you don't work well with others. And that you actually don't have a group where you can really have collaborative care. But what I think is happening right now is that there's this push for volume. And I don't know if you're hearing this from the other guests of your other podcasts and people you've spoken to, but definitely on the clinical side.
I see this push to cycle, right? Meet Susie today, cycle her next week. And as part of that push to volume. It might be because of managed care. It might be because reimbursements are going down. It might be because there's increased access to fertility services. It might be because there's increased public interest in fertility services.
What we see is that quite often, people get into this rut and just keep doing things over and over again. And then they don't have time to actually mentor and sit down with someone. And so what I think you're hitting at is a really important point, which is. These fellows need mentorship. We don't learn in fellowship. How to bill, how to approach a patient, how to recruit a patient, how to get rid of a patient how to refer a patient out, right? Like none of that stuff you get to do, because as a fellow, you're pretty much the grunt worker in the middle and the patients come to the clinic and then you have the opportunity and privilege of taking care of them.
What I think is happening right now is there's this. This push for growth. And is it private equity firms? Is it the commoditization of women's healthcare? I don't know, but as we see this, continued growth pattern where everyone needs to grow and grow, fellows are just getting hired and going into these practices without taking a step back and saying, sure, I want to work for the Yankees, but I wouldn't work for the Yankees if there's no batting coach I wouldn't work for the Yankees.
If there's no one who's going to help me learn how to learn the plays and I think that part is not happening for me. I came out of fellowship and I had a year before this practice opened. I had a year to work with Dr. Schoolcraft and his team in Colorado to not only learn his playbook, but to learn the team of how to talk the talk, how to walk the walk and I'll tell you, I will never, if I could do it all over again, I would not change a thing because I spent a year helping with monitoring of patients who were from Colorado in New York city.
And during that time, I got to learn their protocols, learn the treatment plans, to think about how that group was thinking about the patients. Which I think every day has benefited me now in my clinical practice.
Griffin Jones: [00:14:53] The difference here might be in the difference between a partner position and associate position because when most doctors are leaving fellowships, they're becoming an associate of a practice.
They're not a partner of the group yet. They sign an employment contract very often. The terms for partnership are not elucidated in that employment contract, but either way they're expensive. They're a quarter mill, maybe 300,000 a year. That's a big investment for a good plus whatever benefits and training and other considerations on top of that.
So that's part of the reason why they're going into work-horse mode is because someone is paying them a big salary off the bat and they need to recoup that. So that's what I want to understand about a Denovo center, especially one with CCRM, because that's different from being an associate doc isn't you're buying in, you're putting capital in and you're starting a group within the larger group.
Can you talk a little bit about how that works?
Dr. Brian Levine: [00:15:53] Sure. So I've always enjoyed the entrepreneurial side of medicine and I'm a very patient person, so I was willing to have the conversations with. Colorado about what's long ball look like what's a five-year plan. What's a 10 year plan. And that's what you have to think about when you're building a Denovo clinic.
I recently spoke to a fellow who talked to me about starting a clinic and hoping to flip it or get it acquired. I was like, you didn't spend 11 years of your life to learn how to flip a clinic. Hopefully spent 11 years of your life to learn how to help patients.
And if you're thinking about flipping clinics and you might be on the wrong side of healthcare right now. And I think the fellow was a little taken aback when I said it, but I was very honest because if they're thinking about pumping up a clinic to then flip it that's the wrong approach because I think if you're going to build something, you have to have, at least my view was that this will be my first and last job.
I'm going to cut my teeth at the same desk that I hope to retire from. And that's the way I walked into this and, along the mentorship lines there's Dr. Schoolcraft, who is the founder and physician, but then there's also a CEO of the entire organization, Jon Pardew, who to his benefit is a very approachable individual.
I don't actually think I know anyone who calls him Mr. Pardew. Like everyone knows him as Jon. And that is a benefit for us in that as we had all these business questions and expense questions and how do we model things and how we put it all together, you had Dr. Schoolcraft helping with the business and, he trusted Jon.
And then you had Jon who is helping us understand the finances behind it. So it was this dual mentorship as we were building literally from scratch.
Griffin Jones: [00:17:39] So why is it important to you that you want to be a part of something that stays for a while, or you want to be in the same venture for a while?
Because I'm not sure I don't disagree with your view that maybe it isn't the best idea to flip, but I also. It's not immediately obvious to me that it's necessarily a bad decision entrepreneurs do different things all the time. And just by launching a venture in that way, you can learn so much and it might be what's necessary to be the base for the next venture.
So why is it important to you to have that long-term continuity?
Dr. Brian Levine: [00:18:12] So with only 40 of us coming out of training on average around the country per year, and knowing that infertility affects one in eight couples nationwide. 12 and a half percent of the people in America will deal with the diagnosis of infertility.
I do think there's an altruistic side where I view that like we should be taking care of patients now, should we be fairly compensated? Absolutely. Should we, should our pay be commensurate with the work that we're doing? Absolutely. Should we be trimming the fat and really trying to make sure that no one's riding on the coattails of the hardest worker?
Absolutely. Like I'm all for clinical efficiency and financial efficacy, right? Like the doctors should be paid fairly and efficiently while the clinic is very efficient. In the same regard though, with the model of pump and flip there comes a point where you have to show unparalleled growth and I would worry a little bit about that individual who walks into that clinic with that goal.
If you walk into that clinic, would that goal that I'm going to flip this thing? What you need to flip it on is exponential growth. And if you're getting exponential growth and the earliest stages, you may be rushing to treat, patients that don't get treated. Other places you might be using a key performance indicator or KPI.
That's not appropriate. Medical indicator of the success of your clinic, but you're saying I can increase revenue, unnecessary tested. I can increase volume, unnecessary cycling. And there is, I would say a push and, thank God again, we have great clinical oversight and I think what sets us apart and we'll get to this is the partnership mentorship model by definitely seen at the smaller other clinics.
Where all of a sudden, they open in year one, it's 50 cycles, year two it's 400 cycles. And you're like, how did you do eight X? Then you find out, 46, 47 year-olds are told that this is the place to go, for your first IVF cycle ever. And the donor egg conversation is not happening.
Griffin Jones: [00:20:15] That's a very interesting view on the difference of the business KPIs versus the medical KPIs. And if your goal is to flip, then you're probably doing a lot of those things, possibly prematurely, and. I think there's an interesting constraint that I'm, I've been given by one of my favorite business minds.
His name is Blair Enns, but he gives his readers, listeners, clients, the constraint that you can never sell your business. Not that you won't or shouldn't, but just operate with that constraint and notice the difference in the type of. Venture that you build. And I think that's been very true for me too, is in doing that is whether I sell Fertility Bridge someday or not.
I have no idea, but I really like what I'm building right now and the way I'm building it is different because it's as though I'm going to be the one that ends up with it.
Dr. Brian Levine: [00:21:14] It's an interesting view. And again, when you speak to young fellows who are coming out. They all stress over their contracts.
And I'm sure you've heard this as well. So there's this, SREI annual retreat that used to happen in August. And you do this between your second and third year, and he'll be talking about the contracts that they're, they've received, or the contracts that they're reviewing and people get so focused on how they're going to break up.
Like, what's the exit, what's this, mean what does this non-compete and I tell everyone the same thing. I'm like, if you're looking for what the exit is, if you're looking for, where's the pin to pull the grenade to set the grenade off, you're not looking at the right big picture.
You should be looking at your contract of where's my opportunity to demonstrate my value to this practice. Where's my opportunity for partnership, where is my opportunity to accelerate if possible, my responsibility, so that I can increase my productivity and also increase my share of, my take home.
That's a very different approach that very few fellows, I think right now we're looking at.
Griffin Jones: [00:22:25] I think one thing that's really missing from employment agreements is the terms for the buy-in trend. That's the source of a lot of frustration that I see in associates leaving a practice after two or three years, they thought that they were ready to be a partner.
The existing partners felt differently now, whatever was the source of that disagreement. There's multiple sides to any argument. I wasn't a fly on the room in those situations. But what I can say in summary is that there was a difference in expectation that could have been enumerated or at least made much more explicit in the buy-in agreement. I think what you're talking about is it maybe is a little bit more about that. Okay. What do I have to do? And spelling that out more to be a partner, rather than just okay. When it doesn't work out in two years, how do I get out of that?
Dr. Brian Levine: [00:23:15] Yeah. And I think, and I give everyone the same advice.
If you're looking for a job at CCRM or you're looking at, some other place cause for academics is very clear, right? There's not going to be a partner. When you're in these academic constraints at these academic practices, You're going to end up becoming an employee of either the department of OB-GYN or the independent practice that's employed or owned by the hospital.
So the view is very different. And maybe you will be dealing with RVU. So you'll be dealing with a different system of how you figure out your compensation plan, but on the private practice side, people get wrapped around the axle about the non-competes and what's going to happen.
And what do you mean I can practice in New Jersey if I lose my, I quit my job in New York and. And it drives me bonkers. I'm like take a step back. Think about growing yourself and growing that practice. So the point that you say, how do we open up a practice in New Jersey? How do we open up a practice in Connecticut?
Does this contract limit me from the ability to grow this practice to where maybe the partners don't have the time or the energy or the resources to do this today. And that's a very different deal.
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Griffin Jones: [00:25:58] Brian isn't there more contract angst if you're signing up to start a Denovo clinic, because instead of okay, you the entity, are just giving me a salary to become your associate, and then there's the opportunity for my me to buy in and two or three years, it's, I'm putting down capital now to start something with you.
And that seems like there'd be a lot more X'd.
Dr. Brian Levine: [00:26:19] So that's the unknown, right? So that was the scariest part of it because I recognized very early on that this was the least popular decision that I could make which was to start a new practice in New York when there's some really great, well-established practices and that it would ruffle popular among who I think of amongst the other practices, mentors other individuals, there's always.
There's always concern about the new kid on the block. And part of inherent in training of any fellow or resident is learning the playbook of that practice. And so I do think that there's an element there of secret sauce that people don't want shared in the local market.
Griffin Jones: [00:26:58] I want to talk about New York as well because we had Dr. Bob Stillman on the show a few weeks ago. And when he was talking about shady groves history, he was talking about New York and He talked about the other east coast markets that they went to first because there was not a dominant single group there. Contrast with New York where he described it as sumo wrestlers, that the reason why there wasn't one dominant group is because you had a few sumos that were the equilibrium of that in the ring. And so how did you decide this was the ring you wanted to get into these sumo's knowing that you are a New York guy as you described, but how did we get from meeting Dr. Schoolcraft in Boston to doing this opportunity might take you to Denver to saying, I want to stay here and do this in Manhattan.
Dr. Brian Levine: [00:27:49] So I told him the truth. I'm a highly competitive individual, but in Denver, the bagels are terrible. The pizza is terrible and I can't get behind the Broncos being a lifelong Giants fan.
So I was like, if you don't have football, you don't have good carbs. I just can't live there. So how do we bring your clinic to New York? Because I'll be a much happier individual. That was literally the elevator pitch now in full transparency. Since that time, my father-in-law has switched me to come a Jet's fan and I probably wish I was a Broncos fan because at least the Broncos have been in the super bowl in recent history.
Griffin Jones: [00:28:22] Brian, if you're switching football teams right here on the podcast, I'm not believing your conviction in any NFL club whatsoever.
Dr. Brian Levine: [00:28:29] Yeah, unfortunately, my father-in-law pulled the meanest ever, which was the night that I asked for permission to marry my wife.
He asked me if I'd become a Jet's fan
Griffin Jones: [00:28:37] You failed the test, right? I'm sorry. But my father-in-law said that you've got to root for any other team, but the Buffalo bills, it would be over. So this was part of your pitch. And then, but what was the value prop to them
Dr. Brian Levine: [00:28:52] New York, it sounds very cliche and very Frank Sinatra, but if you can make it here, you can make it anywhere.
Now, of course, I didn't know what their growth plans were for the future. I didn't know that in 2021, there would be 11 Denovo clinics around North America. Oh, sorry. 11 fertility and fertility clinics around North America, including Denovos. I had no idea what their plans were for the future, but I felt that New York was lacking CCRM science and as a geek and as a tech person, that science resonated with me.
Unfortunately, what I realized early on would be that even though CCRM has the fastest path to parenthood, right? We focus on this, right? Like we focus on how do we get someone pregnant and how do we get them to achieve their goals and whatnot? That's what we talk about every day is how do we be faster at this?
How do we get someone more efficiently, pregnant efficiency, being fewer cycles, fewer transfers, better outcomes, whatnot. I felt that in the current practices that existed in New York, I was going to end up meeting resistance. If I tried to incorporate this CCRM approach at these other places. So literally, why compete at those places when you can compete with those places?
And I think competition is a good thing. Everyone thinks it's a bad thing, but competition is good. It makes us all better, right? Like when you become complacent, you're probably not a good doctor. One size does not fit all. Unexplained infertility is a frustrating diagnosis and that should not just be something you check off on your cert data and call everyone unexplained.
You should dig deeper and figure out why it's unexplained or why they're not getting pregnant. So for me, it was all about how do we integrate a high tech high touch clinic. Into the most competitive IVF market in America, right? More fertility clinics are within five square miles of where I'm sitting today than anywhere else in the United.
Griffin Jones: [00:30:46] So what was the hardest part about starting in that landscape?
Dr. Brian Levine: [00:30:53] I think the hardest part was the honest conversation with Dr. Schoolcraft and CEO, Jon Pardew, which is. So we're all excited. We want to get married. We're dating, how do we do this? And the hardest part of it was recognizing that the real estate costs in Manhattan for five to 10 times what they were in any other market that either CCRM was already affiliated with, or that they were looking to expand to.
That was the hardest part to be quite frank was just, it was a numbers problem. It was literally an issue with zeros of understanding the market. Now you can do deep analysis of what is the payer mix? What is the population of New York look like? Is the, are the needs met or unmet? We actually made a heat map at one point, looking at the map of Manhattan, figuring out where the actual clinics were.
I don't know if you recognize it or not, but CCRM is on 53rd and seventh, which is in the heart of Manhattan. Suppose the many of the other clinics, which were where people lived, right? Upper east side, or, in the thirties on first avenue or on the upper west side, we took a different approach, which was, let's go to a place that has high touch, high transit near the subways, near the path train from New Jersey, near port authority for buses to come in near long island railroad from Penn station.
Let's pick a place that's near where people work so they can get treated and get to work.
Griffin Jones: [00:32:14] So we have to revisit your value prop because I imagine your value prop was revisited during that difficult conversation, that if you can make it here, you can make it anywhere. That's reason to go to New York five to 10 times the cost of real estate, probably not going to make five to 10 times the amount of profit.
So what is really behind this sentiment of, if we can make it here, we can make it anywhere that's truly advantageous to the entire company.
Dr. Brian Levine: [00:32:41] So right at the time that we right at the time that we were really having these conversations we looked at the data, how many patients were flying from New York and the east coast out to Denver.
How many patients could be flying out to Denver? How many patients are probably just frustrated and either staying at their current clinic or just unmet needs and are just giving up. And when we had that conversation about the inherent volume that was currently in New York at that state of time in 2015 of what was sitting in New York City, either the unmet need or the defined number of patients that were already doing there, there was enough volume to support the finances of the clinic.
So it was a very calculated financial decision. But the other thing we recognized was that I couldn't do it alone back to our cold concept of partnership. We recognized early on that I was going to need to bring partners on people who are well experienced, people who had volume behind them, people who had demonstrated their own volume at other clinics, because you have to remember coming out of fellowship.
You're an unknown, not just me, anybody, anyone out of fellowship, you don't know how. What they're going to be like when they're actually practicing medicine. And so it was that unknown, which was me, but I think I had to the grit and the stomach for the growth phase, and then taking some people who had demonstrated interest in transitioning to new jobs who had growth who had growth behind them.
Griffin Jones: [00:34:13] What has that growth been like since the inception in you? You had this conversation, I think in 2013, I think you started working on opening the practice in 2015. Is that right?
Dr. Brian Levine: [00:34:24] Yep. I finished fellowship in June of 2015 and that's when we started,
Griffin Jones: [00:34:28] What is growth been like since then?
Dr. Brian Levine: [00:34:30] A 50, 50 mix of absolute excitement and absolute exhaustion.
It is not felt like we've taken our foot off the gas since we started doing over a thousand cycles pre-pandemic a year from starting at, 200 our first year. So each doctor, if you average it out; call it two 50 per doctor, which is I think a very comfortable number as I'm to now really having banner months for the last.
By actually the last six months now, as we've recovered from this pandemic at a 20% growth rate compared to what we've done in the past growth has been continuous and patient volume. We've, haven't grown in the other two places, which I hope we do. One is in the number of doctors, right? We're still four.
We've been four really, since we opened the doors June 1st, 20, 21 will be our five-year anniversary. We are still four doctors since that time. We're still one location. We do have, a small site that we use two days a week for monitoring, but we haven't done the big growth you've seen with other clinics were in a five-year span, they'd gone from four to eight doctors or on a five-year span they've gone from one location to three or four satellite locations.
I do think that there's an issue that occurs. In many of these other practices where they put the junior person out of the satellite that doesn't allow for that mentorship as we were talking about before, I also don't think that feels very much like a partner because you're saying let's farm you out.
Griffin Jones: [00:35:59]
But weren't you firmed up right? Weren't you the ultimate satellite you're New York to Denver, as opposed to new Rochelle to New York.
Dr. Brian Levine: [00:36:07] I never felt like that. I felt like from the beginning that Colorado was our biggest cheerleader. They wanted us to succeed. They wanted to see, their New York volume, go down as our New York volume went up.
I never once felt like we are, taking from the mothership. I always felt like it was let's grow together, which is really important because there's a lot of really tough stressful days. And. You know there when we first started. And you should definitely have Jon Pardew on here and he'll tell you his whole story of his team and, the initial management team that was there, that he worked with, but there was this attitude that I still maintain to this day, which is just to do one more, one more of anything, go see one more patient, come in, an hour earlier to see one more patient, stay an hour later, see one more patient figure how you can just do one more.
And what happened was during this initial growth phase, especially 2016, 2017, where we really, I think hit our stride and just continued to grow from there. Was this attitude of let's build what we have and let's kick the tires, right? Let's look introspectively, let's figure out what's working, what's not working.
And let's optimize before we get too big for ourselves. Which has been really important.
Griffin Jones: [00:37:19] So now you're at a point where it sounds like you're ready to add on a few more doctors. Perhaps this will be a little bit of recruitment advertising for some of the fellows that are listening. If they want to go to New York, maybe reach out to Dr. Levine. I want to talk about another dynamic that I hadn't thought to talk about until you just made me think of it, which was yours. Growth and then the hindrance of not having other physicians. And so I'm introducing a hypothetical here, but when you're. In a group within a group, sometimes they might not have the same needs.
And so part of the reason why you bought into this whole thing was because you wanted their process, their methodology, their system, but what happens when a certain. Location region office runs into different challenges. And I'm thinking, what if there's a place that has four docs and they're doing a thousand, but now they could be doing 1250 that the new patient volume just keeps stacking up.
We'd love to be using advanced providers here. This is a hypothetical, I'm just saying, not saying that's what one group wants to do or that the system doesn't want to do, but there can be. Different needs of the systems, so we don't do that. And then, so how are those differing interests reconciled?
Dr. Brian Levine: [00:38:38] Wow. So that's, I think that's a tough that's a tough one because you need to drink the Kool-Aid or not. I think when you're doing what I did and I very early on. We recognized that outcomes speak for themselves and you can define outcomes, however you want. Those could be pregnancy rates.
Those could be in my opinion, the more important than just pregnancy rates is patient satisfaction scores patient satisfaction rates, online reviews feedback from colleagues. Asking people in the community, like if you need a treatment yourself, where would you go? If you need your sister to receive treatment, where would you go?
And so I think what you're hinting at is you do need to drink the Kool-Aid of the practice that you join. You do need to understand that there is a well-oiled process, that's there. But to be for all the fellows who are listening out there, when we're looking to hire someone for CCRM. As important of an interview is meeting the doctors in the practice of the location that they're going to go to.
And speaking with Dr. Schoolcraft and the leadership team is a visit to Colorado is a visit to the lab to see how, the science is integrated into patient care. To understand the science is not tangential to the care, but it's actually part and parts of what we do and to understand how the protocols are being optimized, how the laboratory environments being changed.
When people started to see that a laboratory environment has vertically integrated with a genetic testing core and together, these two things are talking. It might sound like a minor point, but for example, many practices in America use a third-party vendor for genetic testing. Very little conversation occurs between that third party vendor and the laboratory leads of the clinic that's using that service.
In our environment, because they're all under one roof, we've got a ton of crosstalk that's going on. When we're talking about the mosaic embryos or the no results, or the embryos that come back without enough genetic material to make the call, the inconclusives, it's a very different conversation.
For those patients, because we can tell them that the genetic testing people are talking to the laboratory people and together we're talking about the environment and the medias that we're using and the techniques that we're using now in the same regard as you were hinting at I'm not going to go change the lab.
Even though I'm a doctor and I utilize that lab freely, that's not my place, like I kind stay in my lane, which is, I take care of people. And I sleep at night really well, knowing that there is a killer lab, like there's an engine to this place. That's churning out great results. And there's a bunch of people who are much smarter than me behind the scenes.
And I have the opportunity in New York to reach into that resource, to work with those people.
Griffin Jones: [00:41:29] That is an extremely interesting thought to conclude on. But before we conclude, I would like you to leave with. Thinking back to all the mentorship that you received from Jon, from Dr. Schoolcraft, from what you've learned yourself in the last six plus years, what should fellows be studying, learning?
What should they be seeking out either in terms of learning on their own or learning from someone else with regard to the next step of their career or business? Before they leave fellowship.
Dr. Brian Levine: [00:42:05] So I think, in the second year of fellowship, which is, what I call the messy middle of fellowship, right?
There's the first year, you've been OB-GYN for four years now. All of a sudden you're like, it's like drinking from a fire hose, right? New language, new talk, new procedures, whatnot in the second year where you're really starting to cruise along and you're starting to, get into your groove, take a step back and take a look at either.
Where are the patients are going when they're dissatisfied, where the patients are coming from. And the doctors in the group that you think are most satisfied with the current setup and talk to them. Like I remember in fellowship, I used to ask people all the time, are you happy? Fellows are very scared to ask these questions, but ask them in attending.
Are you happy? Is this what you imagined? It would be like, is this what you were hoping for? And people will tell you the truth and right. You had someone start talking just, you have to, of course, if you're going to ask a question, be a good listener but ask them and people are very honest about their experiences.
This is the purpose of ASRM. This is the purpose for PCRS. As a fellow, you should also take a deep dive into yourself. What do you want to do in a private practice? You probably have more control over your schedule. In a group practice, private or academic, less control over your schedule in an academic practice, you probably have less risk and more stability.
So you have to understand that. What is your personal threshold? Where does your rheostat get set or your risk reward ratio? Because you can actually make much more money potentially. If that's your goal in academics and private. But you could potentially have equity on the private side and not so you could play long ball with it and you just got to figure out, like, where do you wanna turn that dial?
Like where do you want to be? The last thing I would say is that for any fellow who's out there is talk to anyone, everyone we're not all competitors. Like we were all fellows too. It's actually really humbling when a fellow reaches out and is Hey, can I ask you a question?
You don't know me, but I'm a second year. I'm a first year. I'm a third year. Or can I find some time to chat with you? Most likely we'll even pick up the bill and pay for the dinner or the coffee or whatever else, or pick up the phone reach out there's our community of fertility doctors is so small.
And when I hope happens in the next 15 years is that as that generation that started this field really. Ages out and retires that you start to see this other crop of collegial people. I actually like the people that I work with of other clinics. I mean many of us trained together, residency or fellowship.
We like each other, we refer to each other. And I think if you can demonstrated for the fellows out there an interest in being collaborative and an understanding of the collaborative nature and that taking care of a patient as a partnership. No one ever got pregnant from just one doctor.
It's a team of individuals behind that doctor that worked with that doctor that worked with that team together. You'll kill it, but just got, figure out again. I think the big picture is where's your rheostat set. Are you on the risk side? Are you on the reward side? And what is your reward? It's not money for everyone for some people's stability and control their timing of their schedule.
But reach out. Reach out to everyone, reach out to Griffin. You talk to more people than, probably anyone else out there. So just talk to people.
Griffin Jones: [00:45:23] I'm happy to make those introductions as well to anyone that I know, not the least of whom is Dr. Brian Levine. Dr. Levine, thank you for coming on Inside Reproductive Health.
Dr. Brian Levine: [00:45:36] This has been a lot of fun. Thank you so much. Stay safe.
Narrator: [00:45:41] 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 thrives beyond the revolutionary changes that are happening in our field and in society, visit FertilityBridge.com to begin the first piece of the fertility marketing system, the goal and competitive diagnostic.
Thank you for listening to Inside Reproductive Health.