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Growing fertility networks need more staff at almost every level of the organization. But they can’t get enough of them.
Today's guest, Beth Zoneraich, CEO of Pinnacle Fertility, presents her approach to revolutionizing the patient experience and enhancing efficiency in fertility practices.
Tune in as Beth explores:
How she’s refining the patient journey for optimal efficiency. (And why it involves the Ritz-Carlton)
Market and workforce factors driving the need for more streamlined processes.
Pinnacle's automation of EMR steps and improvements in patient intake.
Strategies for segmenting and training specialized support staff.
Navigating the separation between business and medicine in fertility.
The impact of private equity on fertility practices and standards of care.
Beth Zoneraich
LinkedIn
Transcript
[00:00:00] Beth Zoneraich: Why is sort of the industry changes in the industry dynamics affecting fertility? And why, why is it making it now the reason why these clinics need to change? And then in changing, we create these new operational methods, which focus on work life balance and. efficiencies because it's the only way we can go from being sort of a mom and pop, you know, fragmented industry to a scaled, able to give more people access to care, but efficient, you know, group of clinics is, is by making these changes.
And, and we need to make the changes in a way that works for sort of where employees want to be.
[00:00:42] Kevin Ali: Hi, I'm Kevin Ali, CEO of Organon, and at Organon, we're committed to engaging with leaders across reproductive medicine. So I'm excited to introduce today's guest, Beth Zoneraich, CEO of Pinnacle Fertility.
Sponsor: This episode was brought to you by Organon, Organon is committed to championing care equity in fertility. By elevating education, expanding resources, and investing in innovative solutions, Organon stands with aspiring parents on their unique journeys. Learn more at FertilityJourney.com.
[00:01:04] Griffin Jones: Thank you, Kevin. You made me realize that I may have been mispronouncing Beth's name incorrectly in this interview, and I am correcting myself and I am correcting all of you. Beth Zoneraich. One of the things that fertility networks are supposed to do is to introduce operational efficiencies to the practice of REI.
Beth Zoneraich has been mapping the patient journey for many years, long before she was the chief executive of Pinnacle. So I ask her about what she's doing now to make the patient journey more efficient. And also, what are the market causes that make it necessary to make it more efficient? What are the workforce causes for needing to make it more efficient?
What is Pinnacle doing to automate steps in their EMR? What are they doing at patient intake to anticipate patient needs and desires? How does Pinnacle segment and specialize their support staff? What are they doing to train those staff? I press a bit on the separation between business and medicine.
Doctors say they don't want to be told how to practice medicine. People say they don't want to tell doctors how to practice medicine. I just don't think that business operations and the practice of medicine are completely separable. I asked Beth about that. I also ask about the private equity timeline.
I think there's too much evidence to the contrary that private equity just tanks the standard of care. I don't buy that, not across the board anyway. But I do think it might be the case that private equity backed companies don't make enough necessary investments for the long term because the timeline for the return on investment is too short.
I asked Beth about that too. When we talk about workforce, I think Beth is a little more generous than I am in comparing generational work ethics. But I think the point's the same that the only way you'll get even as much out of the current and incoming workforce as you did from previous workforces, let alone get more out of them is by using technology and systems to make them a lot more efficient.
Let me know what you think. Send me an email and enjoy this conversation with Beth Zoneraich. Ms. Zoneraich, Beth, welcome to the Inside Reproductive Health Podcast.
[00:02:54] Beth Zoneraich: Griffin Jones. Thank you so much. It's a pleasure to be here.
[00:02:57] Griffin Jones: I'm I'm happy that you're here. Your fellow upstate New Yorker originally. So we've we've gotten to connect on that.
We also have gotten to connect a little bit recently on on some thoughts on operational efficiency. And, uh, and I do want to get into that and then what that means for the workforce. Um, but maybe we take it from your view of what's happening in the field. And why efficiency in particular efficiencies are necessary at this time.
What's the bird's eye view of, of what's happening that you think this is now necessary.
[00:03:35] Beth Zoneraich: Thanks, Griffin. I, I love to talk to my own network and outside of the network about what a quickly changing industry, the fertility world is. And we have a lot of these dynamics going on in the industry that are hitting All at the same time.
And sometimes when you're in a clinic as a physician or as an embryologist, you, you feel these industry trends hitting, but, but it's pretty hard to see them in a global context and understand maybe why some things that are changing at the clinic are changing. So when I look out at the industry and look over the past 10 years, you, you really see huge changes.
The first is that within the clinic, delivering care to the patient has become a lot more expensive. Uh, it's become more expensive because we've added a lot to the process. So we've made our success rates and the science has exploded and, and our clinics are much more successful at getting our patients pregnant using things like genetic carrier screening and, you know, biopsying embryos and, and, and doing PGTA or PGTM testing on the embryos.
That's improved our success rates. But if you think about what the clinic needs to do, they're now doing a lot of genetic counseling they've never done before, coordinating that. And they're running more tests, which requires coordination with outside vendors, and then they're spending time in the lab biopsying embryos, and they have to now coordinate two cycles, first the retrieval and then the frozen embryo transfer.
So the amount of work required in the clinic that makes it necessary to get to one cycle is a lot more work and a lot more employee. lab, nursing, and doctoring time than we had had before. Uh, so while that's one big trend that's happening, uh, we also have a shortage of labor, so it's making that labor more expensive.
Um, that's really making caring for each individual patient tougher and more expensive and taking more time. So that's one big industry trend that's happened. A second is, at the same time that that was happening, more and more employers have decided that offering fertility benefits is a needed part of, of what they should offer their employees because everyone should have the right to have a family if they want one.
And so it's a wonderful trend to see more and more employers offering this cure. And with more coverage, more patients are showing up at our door wanting coverage. So it's, it's taking us more time to see them. It's more expensive to see them and service them. And more employers are covering it. But we're actually getting reimbursed a lot less on the back end for each cycle that gets covered.
So when you see all these trends happening, a lot of times what we're seeing is we go in and either acquire clinics or or come in to help clinics manage those industry trends. What you find is long wait lists of patients. It's hard to answer the phone. It's hard to get back to your patients and patients get increasingly frustrated with the clinic because they're not getting the care that, that they really deserve and that they're wanting to have.
And the staff of the clinics get super frustrated because they're working harder than they've ever worked before, trying to provide even better care than they were able to provide in the past, but they're getting yelled at all day by patients that, that are kind of angry with the process. And so what we're finding is a lot of people are either leaving the field or they're getting burned out.
For And they're not sure sort of where the future is going, and they don't realize that these industry trends are really what's causing a lot of this. So when, when we're in clinics, sometimes we'll hear people frustrated with doctors or frustrated with administration. And really what's happening is these industry trends are playing out every day in our clinics and making our employees feel stressed and tired and not sure sort of which patient they should see first and where they should head back.
[00:07:10] Griffin Jones: So one of the things that I wrote down that you mentioned is that things are taking more time now, what specifically is taking more time?
[00:07:21] Beth Zoneraich: I think if, if we go back 10 years, right, people would come in and they would, Almost entirely be self pay patients. So they sign a contract and they would get started with their testing and their treatment cycle tend to be that treatment cycle would have been one cycle.
They would, they would coordinate that patient to have a retrieval and then X number of days later, they would have a fresh transfer. Now we've got to coordinate genetic carrier screening of, of sometimes one, one of the, um, parts of a couple of pretend both, you know, husband and wife and or, uh, two, two spouses.
Um, or an unintended, you know, partner. So some of the times we're doing the genetic, um, counseling and the genetic carrier screening, then we're coordinating a retrieval cycle. Then we're typically creating embryos, freezing them as we biopsy them and send them off for treatment. We've got to coordinate with an outside vendor and do that internally.
And we've got to get those reports back. So when you 10 years ago, we've added a lot more steps into the process. And we're now trying to coordinate with More outside vendors and and those coordination with outside vendors can mean lots of paperwork to fill out lots of faxes to get in Lots of attaching to charts.
So there's a lot of steps involved in making that journey for the patient work seamlessly now Unless we put a lot of care and thought and time and energy into making it work better
[00:08:37] Griffin Jones: So how do you get, uh, so how do you introduce inefficiency into this dynamic? Because a lot of these things that have developed have been, I suppose, to increase effectiveness.
You know, now you've got genetic counseling, you've got genetic carrier screening, you have, uh, you've got more options for third party. Um, but everything you introduce, um, might Uh, lead to it's one more step. Um, how do you introduce efficiencies without introducing something that you're trying to make the inefficiency just one more step?
[00:09:16] Beth Zoneraich: That's a great question. We've actually spent years at Pinnacle now time studying and watching and process mapping the flow of the patient journey. And, and lots of people have done this, but we've tried to be really innovative Not just picking a medical record system, but then innovating that medical record system to kind of automate things along the patient journey path that makes it easier for the for our team and our staff to provide really, truly exceptional patient service while not stressing out the team and making their jobs better.
And whether that be helping them with, uh, prep sheets in advance for what patient's coming at eight and at 8. 15, at 8. 30, and maybe a picture of what that person looks like and any consent forms they need to sign and why they're coming to the clinic and any copays or deductibles they may need to have.
And sort of helping the front office with sort of a list of all of the employee, all of the patients coming in and what exactly is needed and getting them ready for that in an easy electronic checklist. It, it may be taking some of our vendors and integrating them into our medical record system so that we're not filling out paperwork anymore, we're just doing click, click, click and that order goes off to one of our, our key partners that we work with.
And making sure when the, when we get test results, they result back into our system and. If we have a euploid embryo, it's going to highlight green in our system on an embryo by embryo braces, or if it's aneuploid, it's going to highlight red and the results are going to be right there at a click of a button.
But that we use automation and technology to take some of the really difficult paperwork steps out of what our, what we're doing. Our employees are doing every day for our patients and automate some of that to make their job easier and more focused on providing the amazing patient care that they love to provide.
[00:11:04] Griffin Jones: You talked about answering the phone and the staff's working hard. Patients are getting angry, wait lists get longer, and then, and people are calling. What's your approach to. Patient intake and answering the phone and what can be automated there? Are we at a stage where we can have chatbots do a lot of things or we can have some sort of a I triage or what's the approach to think about that point of intake now?
[00:11:34] Beth Zoneraich: So we try and study intake from many different avenues. So we study intake first for why is the patient calling to begin with? Did we not anticipate the need of that patient in advance? and touch base with that patient before they needed to call us. So the first is, can we reduce phone calls by better educating our patients and better getting them prepped for their cycle of their appointments proactively so that they don't need to contact us because we've already contacted them and satisfied that need.
So we study our phone calls to see maybe we are getting lots of phone calls, for instance, here's an example from a lab because we had the wrong diagnosis code in and sort of labs that we were sending out were getting rejected. And so we need to go in and fix the diagnosis code. And then all of a sudden those.
Those calls will, will stop coming in. So those, those are easy ones that we try and solve. Then what we try and do is, is we've studied good service models. And so we've gone out and said, you know, outside of healthcare, who do we think of as having really good service models? So for instance, we've brought in the Ritz Carlton to speak to our teams twice now, two years in a row.
And Ritz Carlton defines good services, anticipating. The needs and desires of their customers for us, for our patients. And so beginning to pre think, if I'm a patient and I know the patient journey, or I don't know the patient journey, but we know the patient journey, and anticipating what that patient journey looks like and proactively reaching out in advance.
So if someone needs to be on day three of their, day two or three of their period, and we know their appointment's coming up, can we text them in advance to say, Hey, I'm Did you get your period? Are we still good for our appointment? Your appointment in two days? Or should we push it out a day and being able to really think through that before they show up maybe on the wrong day of their period and then say, Oh, I didn't know or we'll have to reschedule and try again a month later.
So when we can anticipate demand, we reduce those phone calls. And then finally, when, when patients do call us, we should be answering in the first two or three rings. We shouldn't, we shouldn't have them waiting on hold for long periods of time. And we should be able to answer their question in one answer.
We shouldn't have to transfer them five times. We shouldn't have to say, we'll get back to them. We should be able to answer them. intake and have trained staff that can answer their questions. And so our goal and and we're not at this at every clinic and in every place where we're operating, but that is our goal to get to is to be able to meet our patients questions and answers in a very quick format, but really anticipate and ahead of time answer their questions almost before they have them.
Our desire is to delight the patient.
[00:14:02] Griffin Jones: What's your point of view on centralized call centers? Because my point of view when working with smaller practices was that the roles that front desk staff had weren't specialized enough. They were, they were pulled in too many directions and they had to be because they just didn't have the volume to have these four people are the people that handle new patient scheduling.
And these three people are the people that, you know, welcome new patients. And these Other people are the folks that do the insurance verification. And, uh, and so it's, it seemed to me that they We're kind of stuck in that inefficiency because they didn't have the scale to specialize. But as soon as they got to a certain threshold, I would recommend, okay, now I'll get a dedicated new patient line, make that a different line than your existing patient line, because they have very different questions, very different needs.
And to the extent that you can have people whose job it is, is just to deal with new patients. How do you view that delineation of responsibilities?
[00:15:08] Beth Zoneraich: Yeah, Griffin, I, I agree a hundred percent. When I have sat at front office before trying to understand the patient flow, the first thing that I notice is the front office person who needs to greet our next patient or check out a patient that's leaving or talk to people in the waiting room.
It's very hard for that person to answer the phone. They, it's sort of like a gamble. When the phone rings, you don't know if it's a quick, I'm going to transfer it to someone. If it's a 30 minute, I'm going to do an intake of a new patient. You don't know who's on the other end of that call. And the front office person, of course, being service focused, wants to be able to greet the next person walking in with a smile and, and get them ready for their appointment.
So they get, they get nervous about answering the phone because they're trying to do an excellent job with the patient in front of them. So separating those roles, uh, quickly becomes really important so that somebody can be focused on in taking the new patient, answering all their questions and, and being able to answer that call within the first ring or two while not trying to be rude or have two conversations at the same time and give both people their full attention.
So we, we always try to have front office only as a backup on answering new patient only calls, but not the main place where new patient phone calls are, are.
[00:16:20] Griffin Jones: I'll route it to when your network like yours, can that be done from one place across multiple practices in multiple geographic areas? What are the pros and cons of doing it that way?
[00:16:33] Beth Zoneraich: So because pinnacle operates from coast to coast, you know, we often have a three hour time difference. So one new patient call center for the entire country, I think might be difficult for us. It's not something we've gone to at this point. And we also have such a large network that You know, having smaller specialized groups that understand all of the different practices and physicians, there are definitely nuances.
Uh, Pinnacle does try and standardize more rather than less so that we can help with automation and help with technology improvement on the back end. Um, there are definitely still differences between the clinics in scheduling or times or, or some of the clinics are in batching schedules for IVF. Others run continuously based on size.
So we have not tried to centralize into one call center. What we've done is more regionalized. Uh, centers and or centers within a clinic, but just not having it all in the front desk position.
Sponsor: Organon is dedicated to delivering impactful medicines and solutions for a healthier tomorrow. Guided by its mission of being here for her health, Organon proudly recognizes fertility providers around the world focusing on care equity.
We believe everyone should have access to fertility education and treatment. By collaborating with providers, advocates, and communities, Organon is working to elevate fertility awareness, expand resources, and invest in innovative products that help more aspiring parents access the care they deserve.
Every journey to parenthood is unique. Organon stands with you.
Learn more about Organon’s resources at FertilityJourney.com
[00:17:28] Griffin Jones: You've been the top chief at Pinnacle for a year and a half at the time of this recording. You worked for the company for a bit longer than that.
What do you, uh, Uh, view as what were in, in that time period, what were the efficiencies that you prioritized first and why did you prioritize them that way?
[00:17:48] Beth Zoneraich: That's a great question. So since I joined the company, uh, I think the main priority was to get everybody on the same technology platform so that we have a base in which we can grow.
So, clinics came to us on paper. They came to us in a variety of different EMR and billing systems, sometimes two or three at a time, and, uh, you know, we've, we've had 12 different, uh, groups join us, and through that, we've done nine different EMR conversions. And as of June of this year, every clinic of ours, uh, will all be on the same tech stack platform.
That's the same copiers, the same voice over IP phones, um, the same Microsoft Office 365 platforms. They will be on the same medical record systems, um, using the same vendors. And we've integrated all of those technologies together. That will give us, and has given us since we're almost there now, this foundation of which to start to build from, and we're just beginning to see what I think will be really exponentially increasing results.
Uh, you know, as, as an outcome from this, as a way of, of doing things to make our patient care and our service levels truly outstanding.
[00:18:59] Griffin Jones: As you introduce these efficiencies, how do you think about the overlap of business operations with clinical care? Because I've become convinced over the years that you just can't totally separate those two different things and, and the tension between business and clinical over the years has been.
Well, you know, the clinician saying, well, we don't want somebody without an MD telling us how to practice medicine. And the business response has traditionally been, we don't, we don't tell you how to practice business or practice medicine. We, we handle the business things. And I, I just think that. That there's an overlap that can't be fully separated.
And, and I think if, if I was in your seat or Lisa's seat or Derek's seat or TJ's seat, or I think that in, and I'm a business person looking at this, like, I, I feel like I would be telling doctors, like, there's no way in hell you're doing ultrasounds. Like we're going to be doing. We're going to have sonographers do that.
And then you can tell me what safeguards need to take place. And then, and then you can also tell me what safeguards need to be in place for APPs to, to be doing these new pay, to be doing IUIs or OBGYNs to be doing retrievals, like you can tell me, but just looking at where the field is, where it needs to go, it's like, we, you're not, we're not gonna be able to stay in business in a handful of years.
If we can't figure this out. And, uh, and, you know, when you think about the number of, uh, of the percentage of self pay patients decreasing, and those reimbursements are often much lower. And so you've got to figure out the efficiencies there. Plus, we're only serving a fraction of the marketplace that needs our help.
Among other workforce inefficiencies that are coming into the place that, that we'll talk about some more, but I, I, you know, from my view, I would be like, like this, this way of being able to, to see more patients isn't totally divorceable from the way people practice medicine. And yeah, I think that I would have a safeguard of.
or a system for, for saying, okay, you tell me what needs to be in place in order for it to be clinically safe, clinically effective, um, not compromising quality of care at all. But like, this is the direction that we're going at from business. How do you think about that?
[00:21:24] Beth Zoneraich: So, you know, I think I'm, I'm a little bit blessed in the sense that I'm married to an REI physician and I've been married to that REI physician for, 27, 28 years, and we started a practice together, so it comes very naturally to me to know that while there's always an intersection of business and medicine.
Doctors need to drive medicine 100 percent of the time. It's really critically important. I last had biology in the ninth grade. I don't have a really, uh, intelligent background in sort of telling a doctor how to see a patient and what to do. Um, but what I, what I found really large success at is being able to identify industry trends and analysis, use things that are happening outside of the industry, um, whether it be the Ritz Carlton or.
I mean, honestly, any of the, uh, case studies that you can read in business and studying other industries and bringing those successfully into healthcare, specifically into fertility. And I find that doctors are great problem solvers. So if doctors are presented with, um, this is just my experience, lots of good data and knowledge of the problem, then they're great solvers, um, and helping innovate the solution.
And then once some physicians have innovated, they're pretty good at working with other physicians to help, help people come along. Change, change management is really hard and it's really hard, you know, as the industry has changed so quickly to keep up with it. Um, but through the medical leadership board where, you know, at Pinnacle, we have one doctor from every practice sits on a medical leadership board and they make all of the decisions when it comes to anything medically about the practices across Pinnacle.
Uh, and no one from the business side votes on that, nor, nor should they. Those are medical decisions that should only be voted on by the, by the medical group. They've been really able to guide us quite effectively in, in meeting sort of these demanding, changing times, uh, but, but through a physician, you know, through the physician lens and, and being led by the physicians.
We, we have a similar board on the lab, lab leadership board. They manage all of our lab decisions and equipment purchases and, you know, and then oftentimes together, I will, you know, the groups will get together in person twice a year, they meet monthly. Uh, they make decisions together, like if we're picking a long term storage partner, that would be both a lab and a medical decision.
They would vote collectively. Uh, and then we have a business leadership board and their job is really to roll out and help solidify all the initiatives and And things approved by the, by the medical and lab leadership boards. Um, but while these sometimes conflict in general, uh, you know, it is critical to us that we remain physician led and that we still tackle the industry problems and the dynamics that are happening in the business.
And we're finding a lot of success with that. We have lots of really active, good negotiations and good, uh, good discussions, uh, but, but I, I do believe that the physicians are leading us through this and we're, and we're finding answers to those problems. in in ways that keep our patient care at the forefront of every decision we make.
[00:24:25] Griffin Jones: What about those things that, uh, you know, they might need to, like switch an EMR or they might need to, um, start using a software or something. And this is where I mean, where I just don't feel like we can totally divorce the business operations from what quality of care is, because, uh, I, there, there's someone that.
work with pretty closely and who's gone through IVF as a patient a couple of times and, um, had, uh, listened to, um, a couple of the advertisers on our show that have talked about introducing efficiencies. And she said, I wish that I had that because. Our, we, we felt like we were totally disconnected and, and things just fell off the agenda and, and people didn't follow back up with us and it felt disorganized.
Um, and she said, we almost, we almost quit our IVF cycle. And so it's like, that's a, that's like a business operation, but it. It almost affected the, the, a clinical outcome because it, she almost didn't stick with it. And so how do you, how do you think about that when you've got to get people to buy into something and they might say, well, I, I think.
You know, I'm used to doing it this way, or I think that it's too in my wheelhouse of being a clinician. How do you bridge that gap?
[00:25:49] Beth Zoneraich: So we use, we use data, uh, to bridge a lot of those gaps. So when we have opinion differences across the network, which you can imagine with 50 REI physicians, we have a lot of opinion differences.
Like there's, there's no, I doubt that not everybody agrees all the time. We, we use the vast amounts of data since we're all on one system and have access to all this outcome data to test theories and hypotheses and opinions and try and put data behind it to try and see, well, does this, you know, specialized DIMM protocol really help or work?
Or does, Something else really a trend look like it's something we need to follow or not follow. And so we try and break down and listen to each to each idea. And then we have the doctors talk to each other. So that's why we have this medical leadership board. And if it's working successfully in seven or eight or nine of the clinics, you know, it'd be unusual for it to not work in the remaining clinics.
And so. Um, we encourage everybody at Pinnacle to travel a lot and visit each other in different clinics. So if we have a clinic struggling with a rollout or doing something, um, that another clinic is already trying, we invite one doctor to fly to that clinic and, and see it with their own eyes and watch how one doctor sees the patient to, to sort of help make the decision of could that work in a, in a different clinic.
We found that to be incredibly successful as a way for physicians and Folks in the front office and folks in our embryology lab to learn from each other. And it's, it's been, it's been very successful to date. And it's also brought the network closer together and made people enjoy working as a team. Um, even if one works on one coast and one works on the other.
[00:27:27] Griffin Jones: You find that it follows that bell curve of the The innovator to laggard bell Curve, where on the, the far left end of the bell curve, you got innovators and you've got your early adapters, and then you've got your late adapters and you've got your laggards. Do you find that, you know, you have a handful of people that are typically the people raising their hands to try anything, and then, and then there's a cohort behind them that, okay, after.
Those nuts have figured it out, then we'll implement it. And then there's a cohort behind them that says, okay, it looks like we're going in this direction and then, and then you've got your last handful that say, all right, we we've got to do this. Do you, do you find that it usually works in that trajectory?
[00:28:10] Beth Zoneraich: I do. And what's so funny is that works, but it's in so many different categories. So in some cases, if it's research, you have someone who's super passionate about research and they leave the network and research, and then they get everybody to come along and participate and do more studies. If it's on technology or innovation or the medical record system, I've got a bunch of early adopters and they will test it out and get together.
And they're actually on a subcommittee of our medical leadership board on on technology, and they'll get it together and then they'll present it. What's really nice, though, is when you have this functioning network, then If we're rolling out, like for instance, in June, when we roll out our last clinic on the medical record system, we will send in 15 plus people.
We'll send in physicians from two different clinics. We'll send in embryologists from a number of clinics. We'll send in front office people. And so as they're converting, they're not stuck with sort of. Somebody, perhaps from the technology platform sitting there training them, they, they get that for sure, but they get the rest of their network that understands how to see patients every day and the role that they're training to sit for a week with those same like minded folks.
And so when the doctors go to chart after their first new patient consult in the new EMR system, they'll be sitting next to another REI doctor showing them the way, uh, so that it, it's an easier transition and it's not as painful as it would have been otherwise so that we're not trying to self discover every time.
or make people go through the same pain points. We've also, as a network, gotten better at this. So our, our last, our last rollout in Seattle with over 400 employees went spectacularly well, went way better than the first rollout we did, um, with our first clinic.
[00:29:44] Griffin Jones: You talked about the market forces that are are pushing this need for innovation.
Let's talk a little bit about the workforce forces that are pushing this need for innovation. I was just at the arm conference and one person there's one speaker there said That if we do nothing just based on the productivity of the workforce that's coming in versus the one that we've had, if, if we do absolutely nothing in terms of trying to see more patients, but even just to see the, the number of patients that we have, we'll need 30 percent more people in order to be able to do it based on productivity, or we'll have to see 30 percent less patients do 30 percent less cases.
In order to be able to see the same number of patients, do you agree with that assessment?
[00:30:33] Beth Zoneraich: I do. And when I look at industry trends and data, we, we do see that it's part of the reason we've started our own embryology school. We are actively, um, considering and looking at rolling out sort of a OBGYN training programs.
We are very active in fellow recruiting, uh, and trying to convince, um, you know, other REIs to come join our network. We, we see very much the need to increase all of our specialized workforce and we spend a lot of time on innovative, creative career pathing for lower level, um, entry level employees into fertility clinics all the way up to navigator positions, um, looking at anyone with a bachelor's of science to increase the number of people entering the embryology field and, and just getting more and more people interested in, in servicing and caring for people wanting to start their families.
It's a pretty easy industry to get passionate and excited about. So that, that makes it easy to recruit people, but we see that as the number one strategic issue facing us is not having enough staff. It it's why the idea of using, uh, technology and integration. is so critical so that you reduce the burden on your staff and perhaps need less of them for that reason, even though there's no question we need more than we have now, but, but just making sure we have enough to fill the gap and that our training and culture and our ability to recruit and, you know, teach people, new people to enter into the fertility workspace is so critical to us.
[00:32:01] Griffin Jones: I think this person's point was that you'd need 30 percent more people just to get the same amount of work done, meaning the number of hours that people are willing to work, meaning the number like what they're just able to do. You know, if, um, the, the, the hustle for lack of a more precise term, uh, the, I would be, uh, this, I want, I put this out to any network listening to any EMR listening.
I would be so interested if, if people were to pull, uh, like five year age cells starting at age 35, because REIs finish fellowship at like 33 or something like that. So maybe like 35 to 40, 40 to 45, et cetera, you know, up until maybe 60 retirement age. Do you think If you were to look at that for if you were to pull all of your areas across all of your clinics, do you think that you would see like a gradual drop off from by by those eight cells?
And maybe we would have to like, uh, curve the data so that we were looking at it. Like when that clinician was, was of a certain age, you know, but, but do you think that you would see the younger docs doing less cycles than the older docs and seeing less patients than the older docs?
[00:33:18] Beth Zoneraich: You know, I never looked at the data that way, Griffin.
So I don't know. Uh, what, what I would tell you is that I think not just with physicians, but But I, I think folks have grown up watching their parents work really hard and are sort of demanding of their employer a, a reasonable work life balance and, and there, there really should be no reason why fellows graduating from fellowship programs right now should not be able to both a, have personal interests like being a parent and being an active parent and engaged with their child and being able to go to their kid's classroom sometimes or make medical appointments and be home for dinner at a reasonable hour.
And be a really active, busy REI physician. Like, we should not be asking our fellows to choose between those two paths, maybe the way older physicians felt like they had to pick. And we shouldn't having to be asking them to work seven days a week and not take vacation days. We've, we've got to innovate the work.
So that these talented fellows can have both because, you know, people, if we're working this hard and passionate about allowing all of our patients having the right to be a parent, we certainly can't tell our own employees that they shouldn't have the right to be a parent and to be an active parent. I think it's a it's a fair request.
And so a good part of the reason why, you know, at Pinnacle we want some level of standardization and some level of a tech platform is to be able to innovate the work to provide a Physicians and lab staff and nursing staff. Uh, a better work life balance and we're finding, uh, we're finding a lot of success with that.
And if you go back to clinics that sort of went through these transformations with us in 21 and early 22, and you go back and, and speak to the wives and the husbands of the doctors. Um, they will tell you they've taken more vacations and had more free time with family than they had ever had before. And it's because we've innovated the work and I, we want to keep innovating that work so that, so that younger doctors want to join us and they want to join us so that they can practice world class medicine.
And be home for dinner with their, with their kids.
[00:35:28] Griffin Jones: But technology is necessary in order to do that, right? Because otherwise it is an unreasonable request on their point. In my view, you know, for example, if, if they're saying, well, I want to make 500, 000 a year and I want to work 40 hours a week or less, and I want to be able to take six weeks vacation, and I want to have the four day weekend every month, and I want to be off for, uh, to be able to, to do that.
to pop out for those school events. Uh, and I want equity in the company. Uh, you know, previously you would consider those things like a trade off, like, okay, you can work less and, uh, and then you can go pick your, your kids up from school and take a little bit more vacation. You're going to make less. Um, but what's the saying a luxury one sample becomes a necessity.
And that's that's not unique to our eyes. That's true of every generation that's ever lived is that that generation had this. So we expect that less, um, without a whole lot of regard to the input that might have generated the output that, uh, they now set as the expectation. So the only way that it can become reasonable is if.
They are a lot more efficient using technology.
[00:36:48] Beth Zoneraich: Yes, and I think sometimes when, when we talk to, you know, new doctors that are coming in, right? They're, they're perhaps protecting themselves as they look up and see someone who's worked seven days a week for 20 years and they don't want to sign up for that.
But I don't sense when I have those conversations that those positions aren't interested in working hard. In fact, they want to work very hard. They just want to be able to work hard and also have a life outside, and it's a fair ask. And so they want to be able to work maybe in their own way, or maybe not always from the office, right?
So could they do consults from home and miss like a really busy, crazy commute in, and or be able to take their kids to school and then be doing telemedicine from somewhere, and then maybe be in the office a little bit later and not spend two hours a day in traffic, or maybe they're not driving between three offices.
Or they're able to be home at a normal time to put their kids to bed and then they sign on to do some labs or to do some other things at night, but they don't have to be back in the office. But, but the ability to, to sort of manage the work so it fits into their lives as opposed, I hear that more than I hear, I just don't want to work.
That's not, tends to be the conversation that I hear these doctors asking about and, and I think I, I truly believe it, it should be the standard we're all setting is, you know, Is an ability to have both. I don't think someone should have to pick between a career in REI and, and a work life balance. I do believe there's a, I do believe there's a middle ground where they are able to have both, but I do believe to get there.
You need some technology and standardization to be able to do the work in a way that other people can help. Um, and that we're automating as much of the sort of paperwork as possible. Um, also for safety mechanisms, if we automate more, we make less mistakes or we have less of a chance of, you know, miscoding a name or something like that.
[00:38:40] Griffin Jones: No, as this technology is necessary to achieve that accommodation. What are the things in the pipeline that you're paying attention to that? Okay, if we're going to get there, it means that we're going to have to automate this. It means that we're going to have to be augmented by this. What are what are those couple things that you one, two, three, Think that in order to get to this where, Hey, you still want to make a lot of money, still want to do, see a lot of patients and do right by them.
You just want to do it way more efficiently. And you want to have this time outside of work. What are those efficiencies that we have to achieve?
[00:39:15] Beth Zoneraich: So I think a lot of the efficiencies are, we have to get the work. Um, if, if we anticipate patient demand in advance, then in fact, they, they ask less questions.
We waste a lot of time in the fertility world. Where someone calls in and leaves a message, and then when they don't hear back, they send a portal message, and then when they don't hear back, they might call again or talk to somebody, but then you have three people, someone trying to answer the phone call, someone trying to answer the portal message, um, and, and however else they've engaged, trying to get back to that patient, and it leads to a lot of confusion and double work and triple work that we can avoid if we anticipate that patient's questions.
So first, we've got to reduce the work to make it more work. Automated and reasonable and, and, and that we're servicing the patient the first time or in advance, um, because that will then give us less to do. Second, we've got to use technology to be to help us. So if we're all on the same platform and we automate a bunch of things on the front end, or we integrate with front end apps and we collect more information online, and then we synthesize that information in a better way, we can make the work easier if we can.
Even innovate and present physicians with, you know, if they spend a lot of time pulling, you know, follow up consults or trying to get ready for a follow up consult, and they pull things from four different places, even if we can automate the pulling of those things to more easily put the information in front of the physician so they're not doing, you know, the work to go to four places to get it, but they're just making the physician call on what to do.
Those are the types of small innovations on the back end that we're actively working on to try and help physicians, uh, do the work that physicians need to do, but not do the work that they don't value. And, uh, so if you look at the types of things we're doing, we're attending AI conferences. We have three or four tests, uh, small innovations that we're doing with AI right now.
Um, we're integrating with, um, apps for intake that, um, will launch and announce here soon. We've announced partnerships with big genetic carrier, uh, screening, testing, and with PGTA and with, um, long term storage that we can integrate all of that into our patient ecosystem. So we've got a lot, we've got a huge data informatics and data team, and they are really spearheading sort of innovating the work, um, and those are the things that, that keep me busy, you know, many days.
[00:41:31] Griffin Jones: These innovations, be they small or big, they add up and they are an investment. This is a, a topic that I've, uh, that I've gone back and forth with, with, with different CEOs, with different people in different camps. I am not of the camp that private equity is bad because it, it, It's, it's going to squeeze everything out because another recent example of close, different close friend of mine went to a clinic, uh, that is not private equity owned is independently owned.
And it was again, another chaotic disorganized situation. She was very dissatisfied with that experience, went to another, neither of these are pinnacle clinics by the way. And they're also in totally different parts of the country. Um, but, uh, she went to another clinic and Our own by a bigger group was owned by a private equity group, and she felt that that was much more organized and efficient, had much better experience.
And, uh, I know the providers of both of the groups that she went to, and they're both nice people, but I also have a little bit of. Uh, a preview into their operations because, you know, yeah, I could see how that one is run a lot more efficiently. So, I've never bought that criticism of private equity funded groups in medicine that, you know, the, the, just gonna, Tank the standard of care because there are clear examples to the contrary.
Um, one criticism that I do tend to buy more is that the timeline necessary for returning the investment for limited partners and in a private equity model is Can be too much of a barrier for introducing a lot of innovation. Like if you, if you got a three to seven year timeline and you're looking at ROIs like 18 months, and, and so every CEO says, you know, well, we, we always look at the long term and I'm just a bit incredulous about that.
How do you view it?
[00:43:33] Beth Zoneraich: So innovation comes in, um, in my mind, less than a Big Bang theory and more in small. Little innovations that add up to exponential results. So, you know, uh, There, there's no question that private equity has, has a timeframe for exit, but I don't find that maybe, maybe I'm lucky and I'm with a really, really good group, but I, I find a Pinnacle Fertility to be probably one of the most innovative organizations I've worked with yet.
And we're making really huge strides in progress. And, uh, You know, we do a lot of technology projects and I have a lot of staff in technology, uh, that, that are really focused on this and I found great support from our private equity group and, and encouraging this. I, I think, I think the good private equity firms and, and certainly ours fully understand that profit is a result of amazing patient outcomes and patient experiences.
That it is, you don't go seek out profit, you seek out amazing patient experiences and outcomes and the result of that is a profitable clinic. And, and so we're really focused very heavily on improving the patient experience and improving patient outcomes and investing in science and technology and research to the benefit of the patient.
Um, and again, I'm confident that profit will follow that, but it can't be the goal.
[00:44:54] Griffin Jones: The conclusion floor is yours. Beth, you can recap anything that you'd like to talk about with regard to efficiencies and innovation, whether it be from a market need or a workforce need, or if there's might be something important that I forgot to ask you, uh, how would you like to conclude?
[00:45:16] Beth Zoneraich: I guess, Griffin, I would just conclude with a big thank you. I think your platform really brings together Some great leaders and thinkers. And I enjoy listening to sort of the trends in the industry and what other groups are doing and what some of the vendors and apps are doing. So, so I appreciate that.
And I appreciate you giving me the chance to come on and, and talk about sort of our view of what's going on in the industry and sort of Pinnacle's way of. of using technology and innovation to, to address some of those. So, so I, I just wanted to say, thank you.
[00:45:46] Griffin Jones: That's Beth Zoneraich, CEO of Pinnacle Fertility.
I look forward to having you back on. Thank you for coming on the Inside Reproductive Health podcast.
Sponsor: Organon is committed to championing care equity in fertility. By elevating education, expanding resources, and investing in innovative solutions, Organon stands with aspiring parents on their unique journeys. Learn more at FertilityJourney.com.
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