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How are clinicians doing?
Patients are expecting more, offering less gratitude, and leaving negative reviews faster than ever. Sound familiar?
Dr. Alice Domar, Chief Compassion Officer at Inception, talks about the emotional toll of working in reproductive medicine and what can be done about it.
Dr. Domar shares:
– Practical strategies for burnout prevention
– The one small intervention proven to improve patient retention
– Results from three psychosocial trials currently underway at Inception
– The patient traits most predictive of treatment dropout
– How Inception Fertility supports providers through empathic communication training
- What needs to change to better support frontline fertility professionals.
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Alice D. Domar, Ph.D (00:00)
Patients now are very different than patients from 30 years ago. they expect way more of the staff. They are more demanding, they're more critical, And so people who work with these patients feel enormous pressure to meet the needs of the patients and that falls on the physicians and the nurses and the whole team. And so people are really stressed.
Griffin Jones (00:31)
How are clinicians doing? Patients are expecting more from their clinical teams than ever. They are quicker to leave scathing reviews and they offer fewer tokens of gratitude than they did in the past, according to my guest. Does that sound familiar? Dr. Alice Domar is back on the program to share what can be done, like burnout prevention, like one tiny little intervention that increases patient retention, three psychosocial trials that she's running right now at the Inception Research Institute, and how Inception and the research institute give her so much free rein to be able to conduct research that helps improve patients converting to treatment and their engagement and their satisfaction and the same for clinicians. talks about characteristics of patients who are more likely to drop out of treatment, cool things that Inception does to support their providers and patients like empathic communication training for clinicians and giving every patient who wants one a copy of Dr. Domar's recently updated book, Conquering Infertility.
During this interview I zigzag between the challenges providers have and the challenges patients have and I think Dr. Domar shows how these issues are interwoven. She also talks about why embryologists face an even greater level of stress and anxiety and the average tenure of a fertility nurse has been cut in half from four years to two years.
Ali got me fired up about fertility nurses. promise we'll tackle more issues in 2026 that are issues for fertility nurses. There are times when nurses are completely ignored and I'm fed up with it. Enjoy this conversation with Ali Domar as she sets the stage for why.
Alice D. Domar, Ph.D (03:11)
I'm the chief compassion officer at Inception. And so I feel like I'm responsible, not just for patients, but for our employees. And it's hard. You know, I think, I know patients now are very different than patients from 30 years ago. They seem to be, they expect way more of the staff.
They are more demanding, they're more critical, they post negative reviews on social media. And so people who work with these patients feel enormous pressure to meet the needs of the patients at the time where, you know, everyone's worried about volume and everyone's worried about, you know, meeting the numbers and that falls on the physicians and the nurses and the whole team. And so people are really stressed.
Griffin Jones (03:58)
On any given night, who are you more concerned about, patients or clinicians?
Alice D. Domar, Ph.D (04:03)
Yes.
Well, you I'm a psychologist and so, you know, I always feel for patients because infertility is such a traumatic journey. But I'm shocked at least on a weekly basis at how patients treat, you know, nurses and doctors and front desk staff and phlebotomists and ultrasound techs. I mean, the lack of respect, the raised voices, the swearing.
And again, probably 90 % of patients are wonderful, but it's the 10 % that make people think about leaving.
Griffin Jones (04:38)
And so it seems like there's been more of this in the last 30 years. They expect more of clinicians. Is there anything that can be done about that? Is any of your research come across things that can proactively address those? will we end up talking a little bit about that today? And if not, is there anything that can be done about that?
Alice D. Domar, Ph.D (05:00)
Well, you know, there is such a thing as burnout prevention and you Liz Grill, who's my work wife, she and I once a year do a, on a cruise ship, a burnout prevention course for healthcare professionals. So the one we're doing in 2026 is a cruise from Athens to two islands and then 48 hours in Cairo. And so we actually have an opportunity with mostly physicians, some nurses, cetera.
to actually do hands-on experiential burnout prevention strategies. But that's what I do with all the Prelude Clinic staff. I do a lot of what we call stress lunches, where I try very hard to give them a sense of what patients are going through and talk about how hard infertility is. And a lot of people don't really think about what patients are going through in terms of, the patient may be nasty to you today. And it's because last night her little sister called and said she was pregnant by accident.
which for an infertility patient is very traumatizing. And so I think it's really important for everyone who works in the field to understand psychologically what our patients are experiencing and all their triggers. But yeah, I teach, we teach relaxation techniques and stress management techniques and communication strategies and how to use these apps to, for example, we got the app company, Calm,
to give us a deal so that every inception employee not only has access to calm, but five of their family members do too. And so I encourage everyone to do some form of relaxation every day or to use them when a patient pushes your button, which happens to a lot of people all the time. But it was interesting, I was in Australia a month ago for their annual, the Australian New Zealand annual meeting. And there was a lecture.
but I got to a little late because I'm on crutches after knee surgery. And it's by a psychologist in Australia named Elizabeth Bancroft, who herself is autistic. And she specializes in working with infertility patients who are on the spectrum and or have ADHD. And she presented all this data on the fact that for women on the spectrum, the prevalence of endometriosis and or PCOS is much higher in that population. And patients who are on the spectrum
handle infertility treatment very differently and they really need in effect special care and their dropout rates are high. And I'm listening to this lecture and I was gobsmacked because in my 37 years in the field, I never really thought about how do women on the spectrum handle this. And I wonder if those are the patients that we see as red flags because they don't interpret things the same.
as women who are not on the spectrum. And so things like fluorescent lighting or a noise in the waiting room may really bother them. And the average nurse or physician may not understand that.
Griffin Jones (08:01)
What's the relation between the population on the spectrum and the population with ADHD? I would generally think those are two very different populations, but do they have commonalities?
Alice D. Domar, Ph.D (08:12)
they do have some commonalities. And in fact, so since I got back from Australia, I've been communicating with Dr. Bancroft and another colleague of hers, because what I want to do is she has a 40 item questionnaire to basically identify triggers for women on the spectrum and or women with ADHD to see if they need and she's developed a program to meet the needs of these patients. And she has a 0 % dropout rate from treatment and women who go through her program and
what I want to do and I'm trying to do now is take her 40 item questionnaire, which is way too long, and collapse it into maybe a six item entity that we can give to new patients to know if they have certain sensitivities that the team needs to know about. You know, maybe a little extra TLC, maybe dim the lights, you know, things like that, which will meet the needs of those patients and allow them
to withstand the rigors of treatment and so they can stay in treatment until they have a baby. That's one of my big goals right now.
Griffin Jones (09:18)
that really would be something that you might be able to prevent some of the backlash that comes from patients who are having a really hard time. If you could get ahead of knowing that there are some particular preferences that maybe are beyond just preferences that if they're accounted for, you get less of that backlash later on. you...
Alice D. Domar, Ph.D (09:41)
It's sort of prophylactic.
If we know a patient has sensitivities from their patient questionnaire, we can hopefully at least know about them ahead of time. And so they don't get triggered and they stay in treatment. I mean, the other big thing I've been working on is to try to, you know, I've been doing this for 12 years to try to figure out which patients are at highest risk of dropping out and what can we do to support them better and keep them in treatment until they get pregnant.
Griffin Jones (10:10)
Tell us about recent studies that you've done or as recent as you're able to talk about and what characteristics are patients most likely to have that are likely to drop out?
Alice D. Domar, Ph.D (10:22)
So I was invited about a year ago by the journal Human Reproduction to write a lit review on psychological interventions to reduce dropout rates. And I thought that'd be, you know, I was very happy to be invited and I did it with one of my interns who was a college student. And this poor kid spent hours and hours and hours and hours hours researching, trying to find any published research other than mine.
on how to prevent or what psychological inventions and they're literally two published studies and those are mine. So either people are not adequately paying attention or people, I don't know why. So the first study we did was, we did it with Jackie Boyvin and it was supported by what's now called Organon. And we recruited, I think it was 240 women, I think anyway, who were about to do their first IVF cycle.
half of them randomly were mailed a stress management packet and had relaxation strategies and cognitive strategies, et cetera, et cetera. And the other half randomly were not mailed that packet. We had no contact with them whatsoever for a year. And then at the end of the year, we looked at the dropout rates. So we never, we didn't know if the women received the packet. We didn't know if they opened the packet. We didn't know if they used the packet, but their dropout rates were 67 % less in the control group.
and they were less anxious and their quality of life was better and they cope much better with treatment. So we published that study and nobody asked us for a copy of that stress management packet. And here, you you could, you know, you would think that any clinic in the world would use say, wow, this packet costs $12. And nowadays you could probably make it all available electronically. So it would probably not cost anything.
And you can reduce dropout rates by 67%. You think that's a gold mine. And then we published another study, I don't know, maybe a year or two ago, where we looked at patients who had had their new patient consult and never came back. And we, three months later, sent them an email saying, hey, we just want to know why you didn't come back. And is there anything we could have done to support you to come back? Sending that email statistically increased their chances of coming back.
doesn't cost anything to send an email. You can do it automatically. So what those two studies showed, there's almost these tiny interventions dramatically increase retention.
Griffin Jones (12:48)
How much more likely were they to come back if they received that email?
Alice D. Domar, Ph.D (12:53)
I think it was 41 % versus, I mean 42 % versus 31%. I think there was an 11 % difference. I don't have the, you think I should have my own stats on my own head, but I'm too old to have my own stats on my own head. It was hugely significant.
Griffin Jones (13:06)
Yeah, but that's, yeah, it's pretty significant. And so that means
you're converting a quarter more of your patients in that case. And we saw something similar. When we were helping clinics with marketing, we would help them a little bit with conversion. And that was one of the things that we found is that if you set up an email sequence and reach out to those patients, you will convert more of them just by touching base with them. And it can be a really low cost.
Alice D. Domar, Ph.D (13:14)
Yeah. Yeah.
Mm-hmm.
Griffin Jones (13:35)
intervention from
Alice D. Domar, Ph.D (13:35)
Yeah. Well, every clinic in this country or every, every
clinic everywhere is hemorrhaging patients because you know, it takes a lot of time and effort to get the patient in the door and then they drop out. And, know, again, from a psychological point of view, someone who has infertility has been trying for a year or two is probably unlikely to spontaneously conceive at that point, which means if they drop out, they're unlikely to become a biological parent.
And if they're dropping out because of stress, is, know, obviously money is the number one reason people drop out. But the number two reason globally for insured patients is stress, which means we're not doing a good enough job. If patients are dropping out because they're simply too stressed to continue, we're not doing our job.
Griffin Jones (14:21)
Last I spoke with you, clinics weren't doing the best job of measuring their dropout. Has that gotten any better as networks are really focused on their patient pipelines? they measuring more now, patient dropout?
Alice D. Domar, Ph.D (14:35)
Yeah, well, because EMR makes
it much easier. So it's much easier. You can push a button and know what your dropout rates are. If you have someone who's able to do that kind of data analysis. It's huge. Dropout rates are huge. And it's global. It's not just in the US.
Griffin Jones (14:50)
did you vary the email at all? like, experiment with this copy versus that copy?
Alice D. Domar, Ph.D (14:56)
mean, the funny thing was it started out as just, I wanted to know why. You know, is it because you got pregnant? Is it because you didn't like the center? Is it you didn't like the doctor? Is it, you know, and then we added a paragraph at the end saying, there's anything we can do to better support you, please, and we gave a person's name and a phone number. And so we did that for, I think, five months. My research assistant at the time sent the email and then she had the audacity to get pregnant and went on maternity leave.
So for three months, we didn't send the email. And when she came back, I said, huh, I wonder what our dropout rate was when we sent the email versus when we didn't send the email. And that's how we got that data. So it ended up being a publishable quote unquote study, but it didn't start that way. It started as me trying to figure out why patients were dropping out.
Griffin Jones (15:43)
In either of those studies or any others, did you find characteristics of patients that were more likely to drop out? College educated women are more or less likely or from this type of background, can you tell us the characteristics of the profile of patients who are more likely to discontinue treatment?
Alice D. Domar, Ph.D (15:53)
Less likely.
So we didn't look at it in that study, and I have not done the research, but there's been a ton of research out of Europe where there, think there are 10 different characteristics that in effect predict dropout rates. And the ones I'm most interested in are being depressed, which more than half our patients are, having inadequate partner support. Ironically, one study out of France showed the more frozen embryos, the more likely they were to drop out.
which is counterintuitive because the more frozen embryos one has, the more likely one is to get pregnant. There are a lot of different, you know, the older, you know, if a patient in her 40s is more likely to drop out than somebody in their late 20s or early 30s, we actually did a study on that. So there is a relationship between age and there's a relationship between prognosis. Then you have patients who have, you know, extremely low AMHs and their physician has said, give up. Yeah, they're likely to drop out. But the ones that we can change.
We can change depression levels. Hopefully we can change partner support. We can't change education level, et cetera, et cetera, but we can change the psychological one.
Griffin Jones (17:07)
That's interesting to me about partner support. was an article in Inside Reproductive Health recently, a company called Q Engage that that they help with a number of different things. And one of them has to do with online reputation management. And they looked at negative reviews and a lot of it had to do with how the partner was engaged or not engaged and to hear inadequate partner support being a factor in dropout. Well, there's some of that
that you can't control, right? But there might be, you can't change if the partner's a jerk, but you might be able to extrapolate some of that to say that, an engaged partner may be able to help more than a non-engaged partner.
Alice D. Domar, Ph.D (17:39)
No, if the partner's a jerk, you can't change.
Absolutely. mean, as I said, the frustrating part is there are some things you can change that people are not changing. And actually, when I was doing that research, excuse me, I interviewed about 250 patients who were fully insured. this was in Massachusetts where people have six IVF cycles covered. And these were patients who had insurance and dropped out before getting pregnant, before using their insurance. And so we actually interviewed them.
And every single one said it was a communication issue with either their physician or their nurse or their team, and they just couldn't handle the stress. And that led to me starting to do empathy training. And so I've been bopping around the country training our physicians in empathic communication. And so in fact, Ferrin has been sponsoring these dinners where I go to any of the prelude clinics and we have a nice dinner.
And then it's actually fun because I explain all the science about empathic communication and I, you know, go through how to actually communicate empathically. And then I have 14 vignettes on the hardest conversations an ARIA ever has. You know, there's no heartbeat on your ultrasound or, you know, your AMH is too low or an employee is not doing a good job or a nurse has made a mistake. And so they role play. So the physicians either play themselves or the patient or the nurse and
the ones who are playing the physician, you know, communicates this to the quote unquote patient. And then I criticize them. I literally stand behind them and they do their thing. And I'm like, okay, that was good, but maybe you could try it this way. And this had a really good impact. I've gotten some really nice emails from our docs saying, wow, you know, you're right. This really does work.
Griffin Jones (19:33)
and they do it right there at dinner.
Alice D. Domar, Ph.D (19:35)
Yeah, they roleplay at dinner.
Griffin Jones (19:37)
Do you find them doing things in the role play that you see patients comment about?
Alice D. Domar, Ph.D (19:44)
Yeah. Again, these are really tough conversations. How do you tell a patient she's got to lose weight? Or how do you tell a couple that they're severe malfact or infertility? These are the 14 toughest conversations. There are a lot of physicians who do a really good job. In fact, what we ended up doing just to really get the message across is we
went to two of our physicians who are just really good communicators and we have the six hardest conversations. And so had these two physicians with like fake patients or fake nurses. So we videotaped this and we had them do it badly as a not to do. And then we had them do it well as a this. So that's to train our younger physicians and how to have these conversations. And that's really helpful because in a med school and residency and fellowship, there's not
any really specific training on empathic communication. And a few years ago, one of our fellows actually did his fellowship research project on this, a randomized controlled trial, and found that empathic communication had a really big impact on how well patients cope.
Griffin Jones (20:52)
Would you recommend or recommend against setting the stage? What I mean by that is when I'm having a direct conversation with someone or if I have to broach a more difficult subject, if I set the stage that I'm going to have a direct conversation about a difficult subject with you.
they're less offended, they're more at ease. And so if I'm a doctor, I might be saying, I'm gonna talk to you about BMI and how that impacts your prognosis and treatment plans that I recommend. Some people might think that I'm calling them skinny or fat. I would never call anyone skinny or fat. And I am only going to talk about how BMI may impact your prognosis and what I recommend. Is that okay? And so I might...
ask something like that to disarm them at first. Would you recommend doing something like that or do you think...
Alice D. Domar, Ph.D (21:41)
Yeah, you'd be a great REI. You'd be a
great REI sort of the conversation like that. I mean, the focus really needs to be on health rather than on weight. But yeah, it's good to sort of what we call an emotional segue to sort of ease into the conversation and just say, know, I wish I had, you know, if someone doesn't have a heartbeat or their IVF cycle was negative, it's like, I really wish I had better news to share with you and to give them that segue into the conversation.
These are the conversations our physicians and nurses dread because there's a lot of bad news being delivered in our field and it's really hard. I mean, the problem with our field is our successes disappear. Once they have a good prenatal ultrasound, we don't see them again. We only see the ones who didn't succeed, who come back again and again and again, and that psychologically can feel catastrophic. So all you see are failures. You don't see the successes.
Griffin Jones (22:39)
So you have a TikTok account, right? Ask Allie, where patients can ask you different questions. Do you get these kinds of questions from patients that doctors would be on the other side of, or is it more of their mental health journey?
Alice D. Domar, Ph.D (22:55)
So I have avoided social media my entire life and it was suggested to me that I stop avoiding social media. So we just started on TikTok and Instagram or as my kids call it, the gram, me recording stuff, but also launching this Ask Allie, really about the emotional aspects of infertility, partner issues, family issues, lifestyle issues, alternative medicine issues, et cetera, et cetera.
And so we literally just launched it a couple of days ago. So I haven't gotten questions yet, but I'm happy to answer them. It's easier to ask Allie at inceptionllc.com.
Griffin Jones (23:30)
Are you going to try and collect them in any way, like putting them into a spreadsheet or anything so that you could analyze them after a long period of time, put them into some kind of sample?
Alice D. Domar, Ph.D (23:39)
hadn't thought of that,
I suspect the marketing department will want to do something with him.
Griffin Jones (23:44)
Yeah, I think that would be really interesting to see putting it into a word cloud and seeing what comes up the most. So they talk to you.
Alice D. Domar, Ph.D (23:51)
Yeah.
I mean, do webinar,
sorry, I do patient webinars once a month and people for like the last 20 minutes can ask questions. And usually there are too many questions to fit in the hours. Then I just email all the patients back. I mean, it's the questions I've been facing my whole career. How do I cope? How do I cope better? How do my partner and I cope? When do I know it's time to stop treatment or move on to donor-agor sperm?
Griffin Jones (24:21)
Do you find that they're asking doctors these questions or doctors telling you they're getting these sorts of questions and they don't know how to answer them?
Alice D. Domar, Ph.D (24:30)
They do get these questions and the ones who have been in the field for a while know how to answer them. I think for the new physicians, it's tougher because most of fellowship training is on the treatment of infertility, not the care of patients.
Griffin Jones (24:45)
So with the Research Institute, tell us more about what and how you do research at the Research Institute.
Alice D. Domar, Ph.D (24:53)
So when I got to Inception, about three and a half years ago, they had this little tiny research section and I actually brought a study with me and it was sort of decided that we were gonna really try to grow the Inception Research Institute and I got a couple psychosocial grants, but it became very apparent to me really early on that what we really wanted to do was attract pharma trials and device trials and I'm a psychologist and I can't be the PI.
And so several years ago, I started to court my BFF, Dr. Gaurang Daftari, and tried to convince him that he would be happy if he joined the Inception Research Institute. And he did. So October 1st of last year, he came on as the Chief Scientific Officer. And so he and I sort of co-run the Inception Research Institute. I am in charge of all the psychosocial trials, and he's in charge of all the pharma and device trials.
Not go wood, it's been incredible. We are at capacity now. We're doing these amazing studies and we're very attractive because we have one EMR across all of our clinics.
Griffin Jones (26:01)
Why is that important?
Alice D. Domar, Ph.D (26:02)
because you can effortlessly do a study and collect data across all our clinics. And so we have a grant now to do retrospective analysis and you literally push a button and you get the data from 50,000 patients.
Griffin Jones (26:16)
So with those two studies that you mentioned previously, were they through the research institute?
Alice D. Domar, Ph.D (26:23)
Yeah, all the research, no, the ones I said about the dropout, that was before I got to inception. So we basically have three psychosocial trials going on. One is with FRAME, which is the coaching support aspect. And we're doing a randomized control trial right now where patients are contacted after their new patient consult. And those who sign up to be in the study have a randomized to get FRAME for free.
and the others are controls for three months and then the controls get framed. So we're in the midst of recruiting for that. We're also doing a FDA registry trial with Curio. So we're recruiting patients who have been told they need to do IVF and they're randomized either to use the Fertilift, which is a new online web-based cognitive behavioral platform and half a randomized not. And then we've been doing, since I got there, trials with Auto.
which is a company in Canada, which has a device that measures 54 aspects of physiological stress. And that's, mean, all the research is exciting, but the auto stuff is cutting edge.
Griffin Jones (27:27)
So all three of these psychosocial trials are going on now.
Alice D. Domar, Ph.D (27:32)
We just finished collecting data on auto. The frame and curio are ongoing now. Auto, we presented at ASRM last year and we're in the middle, knee deep in the data analysis and we're using the biostatistics department at Queens University in Toronto because we wanted to use an impartial stats group. The results are going to be controversial. because what we would like to, what we are
Studying is whether or not stress manifested physiologically, either through the cardiovascular system or the central nervous system, is associated with IVF failure.
Griffin Jones (28:09)
What can you talk about from what you published or discussed at last year's ASRM?
Alice D. Domar, Ph.D (28:16)
The first study we looked at was the, when I say stress levels, I'm talking about physiological stress of patients during their baseline, which was seven days before they started their IVF cycle, and then the stim cycle, so when they took medications. I remember I was at Eschery two years ago with the CEO of Auto, and he had just gotten some of the preliminary results. said, and this is a, the Auto has data from 30 years ago. They work with Navy SEALs and the NFL.
They used to work with like the Russian Olympic teams. They had never seen stress levels like they saw in these women during the STEM phase of their cycle. And so we presented ASRM last year was comparing patients during their baseline versus their STEM phase. And it was P values that I as a researcher can only dream about. was like P is less than 0.0007. So women were extremely physiologically stressed during the STEM phase.
Griffin Jones (29:13)
when do you expect that you'll be able to share the, you publish the remaining results of the second phase?
Alice D. Domar, Ph.D (29:21)
As soon as we can get the manuscript written, we're going to have, we have three different manuscripts. So I can talk about the baseline versus STEM because we presented it. And then we have another manuscript about how we are using, not me, but Queens biostatistics guys whose IQs are three times mine, how they're using AI to create models about whether or not physiological stress can predict IVF outcomes. So that's going to be another paper. And the third one is the actual data.
Can physiological stress predict IVF?
Griffin Jones (29:51)
So are we talking like this time next year or longer, a couple months or?
Alice D. Domar, Ph.D (29:53)
yeah i mean it better darn well
be published within the next six months. I do have to retire at some point in my life.
Griffin Jones (29:57)
How about the,
yes, well, are you gonna? Good.
Alice D. Domar, Ph.D (30:03)
Not for a while. I need to
finish all this research and I have a lot more to accomplish and now I have all this autism spectrum stuff so now I'm not going to retire anytime soon. Too much to do.
Griffin Jones (30:15)
Yeah, we're
giving you more rabbit holes to go down. Too many stones left unturned, Ali. We've got to keep you around for a while. I'll be interested in hearing about the results from the frame trial as well. When do you expect to be able to publish that?
Alice D. Domar, Ph.D (30:18)
Yeah.
Probably a year is my guess. mean, you have to recruit patients and then they all have to go through the three months and then can collect data and finish the data analysis and then write a manuscript which has like eight co-authors on it and you rewrite and you rewrite and you rewrite and then you submit it to a journal and the first journal rejects it. So you have to go to a second journal and then the reviewers will have lots of such, it's a long process.
Griffin Jones (30:37)
Yeah.
Was the research institute part of your initial charge when you came to? Inception was that part of the deal or what you came on as chief compassion officer and then you nudge TJ and say hey I want to I want to do this kind of stuff or did they come to you?
Alice D. Domar, Ph.D (31:09)
I mean, came on as Chief Compassion Officer and TJ and I had six goals for me. And I brought that auto study with me. So I knew I'd be doing a little bit of research and they had a research coordinator, Amber Mendoza, who's amazing. And I think when I got there, you know, as a researcher, having one EMR across all these clinics is a researcher's dream. And so I realized that I could accomplish way more.
at Inception than I'd ever been able to do in my career. And so early on, Chris Bright, who's the president of Inception said, okay, you're the director of the Inception Research Institute. And TJ, I mean, knock on wood, TJ has never said no to me. So everything I go to him with, he's like, don't ask me, just do it. So.
Griffin Jones (31:56)
There's going be a lot more studies about patients with ADHD, DJ. There's a lot of different angles that you can pursue. Do you remember the six goals? Can you rattle them off?
Alice D. Domar, Ph.D (32:01)
Yeah.
No. But I do
want to say is that the Inception Research Institute within about two years of launching it had more trials registered at clinicaltrials.gov than any other network in North America, which is great because it means we're returning. The six goals, gosh, I, you know, no, I don't remember. I'm sure it's in my contract. mean, you know, obviously one was to create as many stress management programs for patients as I could.
Number two was to create stress management programs for the staff. I wanted to put a mental health professional embedded in every practice and that's on hold right now. Maybe research, I'd have to go back and look at my contract. That was four years ago.
Griffin Jones (32:46)
Is it as important to have a mental health professional embedded in every practice as it was 10 years ago? Is there a lot that can be done with virtual therapy in your view, or does it really need to be in person?
Alice D. Domar, Ph.D (33:02)
It's a tough question, because I don't think a name has ever done a study on this, so I can't answer it. I would say that, you know, I was at Boston IVF for 20 years, and I felt like, and there was a whole team of mental health professionals that were embedded, and we didn't just offer a lot to patients by physically being there. So for example, when you're physically embedded, you know, if a patient comes in for a prenatal ultrasound and there's no heartbeat, every patient in that situation was guaranteed to see a psychologist within an hour.
And that's an amazing thing to offer to patients. And it meant that every staff member could come and talk to us. And so I'd say when I was there, it was half patient support and half employee support. I do think right now, mean, since COVID, I have not physically seen a patient in five, what, five and a half years. Everything I do with patients is on Zoom. And we know that therapy via Zoom is just as good. And so, yeah, you know,
and curio are both not live interventions. But there's something about a nice warm mental health professional, you know, physically being there to remind people that they're there. It's important.
Griffin Jones (34:11)
No one's ever done a study on it with all of these therapy apps that are out there now. You would think that someone would have done a study to see if they're as good as in person, but I guess that would be hard to control for, right? Because you have different therapists.
Alice D. Domar, Ph.D (34:27)
It'd very hard. you know,
yeah. I mean, there's, there've been lots of studies comparing, you know, online interventions to in-person interventions, but not specifically that I know of with infertility patients. ⁓ I mean, to be honest, there's very little research going on in the U.S. I mean, it's, I mean, there's almost no money available to do randomized controlled trials in the U.S. I mean, the federal government, I haven't heard of any funded research. So in the U.S. there's really,
Griffin Jones (34:39)
okay.
Alice D. Domar, Ph.D (34:54)
not much going on. So one either has to rely on companies like frame and curio and the pharma companies, auto, it's tough to get funding. So, know, in Europe,
Griffin Jones (35:04)
But
elsewhere in therapy there have been studies and what do those studies show?
Alice D. Domar, Ph.D (35:09)
yeah, yes, yes.
The study shows that remote therapy is as good as in-person therapy. So that's why you see all these remote platforms springing up.
Griffin Jones (35:20)
You've updated your book Conquering Infertility recently. What's new?
Alice D. Domar, Ph.D (35:23)
That's so kind of to mention.
What's new, so, you know, what's really interesting is that Inception wanted me to update it because they are now giving away free copies of Concrete and Fertility to all their patients. so I took the publisher sent me the Word document, which was written probably 25 years ago. And my assignment was to update it. And clearly there was a fair amount of medical stuff. mean, in the first, in the original version, there's
all this talk about having a high FSH, which obviously converts into low FSH. And there had to be updates about PGT and all the other medical stuff. And I added a lot more content on LGBTQ and I changed all the pronouns. when we read the book originally, it was really meant for heterosexual couples and we had to make it much more broad. But the emotional stuff hasn't changed.
I mean, you had to change names, because names that were popular 25 years ago are not popular now. And so I had to look up popular names from like 30 to 35 years ago. But no, the emotional stuff, I mean, I have a small private practice, so I'm still in tune with patients and the emotional stuff I didn't have to revise.
Griffin Jones (36:37)
So Ashley used to be the baby's name and now it's the patient's name. Linda's out of the picture and now the baby is Olivia.
Alice D. Domar, Ph.D (36:42)
Yeah, Karen's out of the picture.
Yes, Olivia, Ava, Maya, know, the names have changed. Like boys have to be, you know, Noah and stuff. So yeah, I did change all the names. I also had some fun. I don't know if anyone in inception has caught this, but I changed a lot of the names to people I work with. So there's Lindsay and Cat and Amber. Yeah.
Griffin Jones (37:09)
That's fun.
That's a good way to test if they're paying attention reading the book. They give it to every patient at every clinic?
Alice D. Domar, Ph.D (37:16)
I don't think anyone has. So any Inception patient who wants a copy
of the book, yeah, they have them in waiting room, people can take a copy. Yeah, they order thousands and thousands of books.
Yes.
Griffin Jones (37:26)
Did you
ever go to inception clinics and do signings?
Alice D. Domar, Ph.D (37:29)
I haven't done that actually, that's a good idea. I I did a book signing.
Griffin Jones (37:32)
That's next. Let's go, Faring. You got something else to
sponsor. Let's do book signings at different clinics. I think that would be cool.
Alice D. Domar, Ph.D (37:40)
I did one at ASRM
last year at the Inception booth and we ran out of books within 10 minutes. Yeah, it was fun.
Griffin Jones (37:47)
Nice. ⁓
Was that the updated version of the book yet?
Alice D. Domar, Ph.D (37:52)
No, that
was, think it was actually two of my other books. I think it was Be Happy Without Being Perfect and Self-Nurture. was for people attending A.S. sermon, it wasn't for patients.
Griffin Jones (38:02)
Well, let's do it again. You have a talk coming up at ASRM. By the time this episode airs, that talk will have already happened. So what did people hear about at ASRM when they're listening to this episode?
Alice D. Domar, Ph.D (38:10)
I know. So Liz Grell and I are
doing it together. It's an inaugural symposium in honor of Dr. Schlaff, who died recently and his family is sponsoring it. So Liz is going to talk. mean, I'm the chair, I'll sort of open the thing, but Liz will talk about sort of what we know in terms of research on burnout and burnout prevention. And then I'm doing real hands-on, like let's do some relaxation techniques.
talk about cognitive strategies, how could you better care for yourself? And then we'll do Q and A.
Griffin Jones (38:44)
What will Dr. Grill talk about that I haven't asked you about yet with regard to what we know about physician burnout?
Alice D. Domar, Ph.D (38:52)
It's actually clinician burnout, not just for docs. ⁓ I saw her talk, you'd think I'd have this sit-in my tongue. I think she just, she presents a lot more data than has been known on burnout in the REI field. know, what physicians are reporting and there's research out of Europe and then ASRM every few years surveys REI nurses. And she's going to talk about nursing turnover and how it's basically doubled in the last five or 10 years.
Griffin Jones (38:55)
Okay.
Alice D. Domar, Ph.D (39:18)
We nurses used to stay in the field for four years, now it's two. And it cost clinics a fortune to replace a nurse.
Griffin Jones (39:25)
Wow. And over what period of time is that? It used to be.
Alice D. Domar, Ph.D (39:28)
So used to be nurses
would stay in the field for four years and now it's two.
Griffin Jones (39:33)
Yeah, wow. And do we know over how quickly of a span that changed? Like was it four years average in 2020 and now it's two? That's such a big deal.
Alice D. Domar, Ph.D (39:35)
Yeah.
I actually don't know. It's ASRM data, it's not my data. But the nurses, they do the survey
and they ask them. And a nurse right now isn't just a nurse, she's a travel agent and she's a counselor and she's a pastoral person. And these nurses have to wear 10 different hats. And they also have to understand the technology because most networks now use portals.
Griffin Jones (39:49)
Yeah.
Alice D. Domar, Ph.D (40:05)
And so they have to understand how to work with the portals and how to use EMR. And nurses honestly are the ones that are sandwiched between these frantically anxious and depressed patients and the physicians. And patients aren't going to take their angst out on the nurses. take it out on the physicians. They take it out on the nurses and the support staff.
Griffin Jones (40:24)
They get ignored a lot too, don't they, the nurses?
Alice D. Domar, Ph.D (40:26)
Absolutely. Yeah, they do.
Griffin Jones (40:28)
I know it because, or at least from where I stand, because I have built a living making a trade media company for the fertility space. My audience is the people that work for, operate clinics, the clinicians, the business people, the embryologists, and I have different companies that market on.
our media platform to those different constituents. And the reason why we don't make more content for and about nurses is because it's really hard for me to get companies that want to target them because they just don't feel like they make a lot of decisions for whatever it is they're selling. if I'm, yeah, yeah. And I think thankfully, yeah, thankfully.
Alice D. Domar, Ph.D (41:11)
Do you see my eyes rolling?
They have huge influence. Nurses have huge
influence.
Griffin Jones (41:20)
I
100 % and what but what it I think they need a larger microphone too. And and I've been working on different companies and I'm like, just give them the mic, give them our microphone and and let them have a bit more of a collective voice. And you'll see how influential they are. And I think that I've gotten a couple people to bite on that I think one pharmacy in particular.
Alice D. Domar, Ph.D (41:28)
Absolutely.
Griffin Jones (41:47)
really understands the importance of nurses, but it's an area where I feel like this is something we should be talking way more of. that fact, I didn't know it in those terms. I could have intuited something like that, but just the fact that you can button it down to fertility nurses used to have an average tenure of four years. Now it's two. It can't have again, right? Like you can't let that have again.
Alice D. Domar, Ph.D (41:56)
Cute.
Huge.
Griffin Jones (42:14)
because then you're talking about an average tenure of one year per fertility nurse. You can't run a clinic like that.
Alice D. Domar, Ph.D (42:21)
Well, it takes a
year to get a nurse up to speed and the practice manager of a big practice told me a couple of years ago that it costs the practice $300,000 to replace a nurse. So it's very short-sighted not to support nurses. And in fact, you should do a whole show with Liz and I that's just for nurses.
Griffin Jones (42:41)
Done. Done. We will do one that is just for nurses.
Alice D. Domar, Ph.D (42:42)
Yeah, because I
worry about the whole staff. I worry a lot about the front desk staff, because they are the ones that often take the most abuse. globally, the front desk staff have high turnover rates, because they're abused by patients. mean, again, 90 % of patients are fine, but it's that 10%. And I'm just making that number up. And they...
Griffin Jones (43:03)
Yeah.
No, wait,
I didn't want to interrupt your thought. I was thinking back to something you said earlier where now the nurses, she's not just a nurse anymore, she's this administrative assistant, she has to do, that's unacceptable in my view. And we have to have a louder voice that nurses should not be doing all of this admin work, especially when the technology exists there. And I don't know if it's the frames out there who I think have a,
good repute, conceive, levy health, engage in MD might be working on some more stuff. There's, and there's other folks that I'm forgetting that I'm gonna feel bad about not including, but they, these types of solutions are out there and it's not okay to just say, the nurses are just gonna call people. One, because that limits, that really restricts your patient pipeline as well, but two,
you are, we're driving nurses out of the field by doing that.
Alice D. Domar, Ph.D (44:02)
And it's, know, so if you have a nurse who's burnt out, one of the symptoms of burnout is you lose compassion. You just, you know, they become, you know, automated and the patients notice and then the patients drop out or the patients post a bad review. And so there are a thousand reasons why we need to take better care of our nurses, you know, for the nurses, mental and physical health, number one, but clinics run on nurses.
Griffin Jones (44:30)
I don't want to
Alice D. Domar, Ph.D (44:30)
In Boston, we say
people run on Dunkin. Infertility clinics run on nurses.
Griffin Jones (44:35)
Yeah.
Who do you think of when you think of most of your healthcare experiences? You think of your interactions with the nurse. That's the person that is representative of your experience in a fertility practice. And if they're not engaged, then good luck improving patient engagement.
Alice D. Domar, Ph.D (45:00)
Well, it's interesting because 30 years ago, nurses got gifts every day from patients. I remember you'd go into the Boston IDF lunchroom and there'd be baskets of muffins or bagels or cookies or fruit baskets, et cetera, that patients would show their appreciation to the nursing staff. And they don't anymore. And it's not funny. So a couple of weeks ago, my father-in-law was dying. He was in an ICU. And he actually died. But you know,
The second day he was, and I was his healthcare proxy, so I spent a lot of time there. And I noticed that the nurses had been given a box of chocolate. And I said, do you guys like chocolate? You know, I'd be very happy to bring in a box of chocolates for you. And you know what they all said to me? Please just write a thank you note. No one writes us thank you notes, but when someone does send us a thank you note, we post it in our break room. And every time we've had a bad moment with a patient, we go into the break room and we read those notes.
So my husband and I wrote long notes for the ICU staff and the ER staff. I still brought donuts every day, but they want to be appreciated. And, you know, again, 30 years ago, 20 years ago, even 10 years ago, patients showed their appreciation. And, you know, we have a new thing at inception that every month the patient experience director assigns each executive, all the employees who got a shout out on social media.
And each of us is assigned however many employees at that clinic got a shout out on social media. And we have this, it's called a bonusly program where people get bonusly points and they can use the points to get, you know, gift cards for pretty much anything. And so every month, every executive gets assigned. And so what we do is, you know, I get my, I see what the shout out is and I send a message to that employee with bonusly points and it's, it's broadcast to the entire company. And that way we are acknowledging.
every employee who got a shout out from a patient. But it should be thousands of shout outs per month and it's not. The patients are just not acknowledging when employees take really good care of them. They post negative reviews, they don't post, I mean, it happens once in a while, but it should be thousands, not dozens.
Griffin Jones (47:18)
I would have thought that nurses were still getting a lot of thank you notes. I wonder how common that experience is. And I think it's a good poll question for us to put out there to fertility nurses. Do you get more or less thank you notes than you used to? And what you just said is it should be thousands. I think that in today's day and age, we're so used to expecting everything to be instant. We're expecting everything to be catered
to us that we've learned some bad habits as a consumer population and that people need to be disabused of some of those bad habits. And that was one of things that I would try to get practices to think about in their marketing that they should talk a little bit about nursing burnout or compassion fatigue in their marketing.
Alice D. Domar, Ph.D (48:09)
They should talk a lot about
it. They should talk a lot about it.
Griffin Jones (48:12)
Well,
so they should definitely talk a lot about but they should talk about a little bit in their external marketing to patients because I want patients knowing that my nurses aren't robots, that they're not these cold steel avatars that don't have emotions, that they are really trying their best that they have so much on their plate. And if I'm coming in with that as my as my preface, then
I can start being more grateful for what they do because what's the expression? Gratitude is expectation minus delivery or minus actuality. So if my expectation is that everything should just be perfect and how dare it not be, then I'm not gonna be grateful. But if my expectation is, these nurses really have a lot on their plate, then I might start to be grateful for what they're doing and express that gratitude.
Alice D. Domar, Ph.D (48:51)
I have no idea.
Griffin Jones (49:08)
You've got me fired up about nurses and I am going to have you and Dr. Grill back on and I'm going to think of some sort of goal. think I can get, I don't want to speak for them, but I'm going to speak for them a little bit anyway to, sort of like, to, you know, like to put it into the
Alice D. Domar, Ph.D (49:10)
Good.
Griffin Jones (49:25)
atmosphere, like Mendell's Pharmacy, I think I can get them to help a little bit with this because they really, they really, really appreciate nurses that they are one of the people that actually stick up for them care about them. I think I can get them to help out a little bit. But I want to 2026 I made a New Year's resolution a couple years ago that I was going to do a lot more content for embryologists. And then boom, it happened and we got more more
Alice D. Domar, Ph.D (49:47)
They're stressed too, by the way. Let's
not forget every other. I just was part of a big study that was published last year.
Griffin Jones (49:51)
We did
Alice D. Domar, Ph.D (49:52)
Embryologists are very stressed because in most of what one does, a mistake can be remedied. An embryologist's mistake can't be remedied in general. everything they do is really high stakes.
Griffin Jones (50:07)
as are they part of the the people that you address? So when you talk about clinician dropout, are they
Alice D. Domar, Ph.D (50:12)
Yes.
always seek
out embryologists. And in fact, several times now I've gone to New York and literally taken out all the NYU embryologists for a nice steak dinner, just to show how much we appreciate them and talk about stress management and everything else. Yeah, embryologists, I would say that when I go to clinics to do these stress lunches, and then I sort of sit in an office just to do one-on-ones with anybody, a lot of the people that come talk to me are embryologists.
Griffin Jones (50:41)
Well, I am going to have you back and we'll talk more about embryologists because they deserve their time. And I'm going to have you back to talk about nurses because I can't get enough of you, Ali. Thank you for coming back on the show.
Alice D. Domar, Ph.D (50:45)
Sounds great. Thanks for inviting me.
Dr. Alice Domar
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