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123: 4 Steps to Fertility Business Goal Setting That Speed up Execution with Griffin Jones

123: 4 Steps to Fertility Business Goal Setting That Speed up Execution with Griffin Jones

This week Griffin Jones highlights four steps fertility businesses should use for goal setting to speed up execution. Sometimes you need to slow down to speed up. Griffin lays out goal setting from an unique perspective and talks about the goal snowball effect. Listen to this episode to gain a better understanding of how to evaluate your goals based on the investment of time and money they will take to achieve. 

This episode covers: 

  • How to set and attain goals

  • How to prioritize goals

  • What is the goal snowball

  • The 4 steps to goal setting to speed up execution

To learn more about our Goal and Competitive Diagnostic, visit us at FertilityBridge.com


Inside Reproductive Health is sponsored by EngagedMD. For technology that educates your patients with true informed consent, visit engagedmd.com/IRH for 25% off your implementation fee. 


Leadership vs. Delegation in Marketing: A 12 Point Spectrum for Fertility Business Owners

By Griffin Jones

Leadership is a delicate dance for any business owner in the fertility field. For REI practice owners, it might be the Tango.

Striking the balance between leaning in and stepping away can be a struggle for any fertility executive, and there is usually an added layer of complexity that’s unique to physician practice owners.

If we look at the Entrepreneurial Operating System (EOS) accountability chart, we see where a managing partner might find themselves occupying many seats.

Visionary, whether they’ve sorted that role out with their partners or not

  • Integrator, if a Chief Executive Officer or Executive Director doesn’t truly occupy the seat

  • Operations, if they are the Medical, Practice, or Lab Director

  • Physician, oh yeah. Remember your main job? The one for which you undertook fifteen years of higher education and training? That seat falls below the leadership seats under operations. 

Yes, executives of many companies, fertility or not, struggle to step out of many seats. Still, the functions of Medical, Practice, or Lab Director, and especially the role of physician, is a unique charge for physician practice owners.

The accountability chart for fertility practices is its own topic that merits its own article. In this article, we will attempt to get you out of the sales and marketing seat as much as possible.

Even when you properly delegate the sales and marketing seat, there are sales and marketing responsibilities that come with the visionary and integrator seats.

HOTEL SALES AND MARKETING: YOU CAN CHECK OUT ANYTIME YOU LIKE, BUT YOU CAN NEVER LEAVE

What do some of the world’s most iconic brands have in common? 

They had or have CEOs (Blakley, Jobs, Musk, ol’ Walt himself) that propagate the market position of the company in everything they do.

If you’re looking for a book on this topic, David Kincaid’s The Brand-Driven CEO: Embedding Brand Into Business Strategy provides plenty of real-world, current case studies from today’s biggest companies.

Leaders must be involved in positioning and branding because the marketing position of their companies is enforced or betrayed in every area of the businesses.

Because principals (the owner of an REI practice or chief executive of a fertility company) are no exception to the positioning requirement, it’s common to get bogged down in sales and marketing responsibilities that they should be able to delegate.

We don’t want that. If you’re struggling with the question of involvement versus delegation in your fertility company, you aren’t alone. 

We’ve broken sales and marketing responsibilities into a 12-point spectrum you can use to determine when you need to be involved in branding, sales, and marketing initiatives and when you can delegate.

12 POINTS FOR FERTILITY BUSINESS OWNERS

The external and internal presentation of your company is a relay race. You have to make sure the baton doesn’t get dropped as you run from one segment to the next. This means that you can’t go from leading your team to being completely uninvolved in one take. In business, a dropped baton leads to inefficiencies and expensive mistakes. In the fertility field it leads to patients feeling like they were baited and switched.

But, you can step out at certain points once the baton has been successfully passed. This spectrum allows you to ease off without sacrificing outcomes.

When you need to lead:

  1. Positioning

  2. Branding 

  3. Growth Goals

When you need to be somewhat involved:

  1. Brand Development

  2. Growth Strategy

  3. Operational Overlap

When it’s okay to be uninvolved:

  1. Coaching

  2. Brand Activation

  3. Strategy Execution

When it’s time to reinvolve yourself in the marketing process:

  1. Culture 

  2. Brand Refresh, Redesign, and Extension

  3. Accountability of Leadership

When the principal of a fertility practice needs to lead

1. Positioning

Positioning influences everything the business does. We’re talking about what differentiates your practice from the competition and what makes it unique. This includes your: 

  • Vision

  • Mission statement

  • Core values 

  • Core service areas and focus

  • 10 Year Target

  • 3 Year Picture

A marketing team can’t make these decisions for the company. They can only come from the top. 
However, it’s also important to note that if you have partners, everyone needs to be aligned before moving forward. Otherwise, the latter stages of the marketing process will become more expensive, more time-consuming, and less effective.

A fertility business can be in operation for decades. However, if they haven’t structured everything they do in a source of truth (that everyone in the company can point to), they haven’t outlined their unique positioning.

2. Brand

Part of the role as a leader of a company is chief brand ambassador (lowercase, let’s be modest here). Once you and your partners, if necessary, have decided on things like core values and which types of patient segments you especially want to serve, you can move on to branding. 

This includes the 

  • Name of the company

  • Unique value propositions

  • Overall brand look and feel

  • Key messages

Your marketing team will be a key player in this process (if they aren’t, something is wrong), but your leadership is still crucial. 

3. Growth Goals

Employees simply can’t decide growth goals because they don’t have the skin in the game that the principal does. As Gary Vaynerchuk bluntly puts it, “Your employees shouldn’t care about your business as much as you do.”

Unfortunately, marketing personnel are often not even incentivized to pursue growth goals. Worse, administrators and operations personnel are frequently disincentivized from pursuing growth goals because it means more work for them and they get nothing in return.

Your growth strategy is the measurable pursuit of your values, vision, and brand. It is the traction toward your vision put into numbers. Growth goals include:

  • Revenue goals

  • Net profit targets

  • What type of business they want the company to be (like a designated B-Corp, for example)

  • Patient satisfaction score targets

  • Number of new patients served

When the principal of a fertility company needs to be somewhat involved in sales and marketing 

During this next phase, you can begin to dial things back a few notches. You still have some involvement in the sales and marketing process, but now your team is starting to run and you begin to extend your arm to pass the baton.

4. Brand Development

At a minimum, every company should have a set of brand guidelines, also commonly called a brand book or a brand style guide. These documents guide every marketing campaign going forward and they provide the templates of your company’s look and feel.

Your marketing team will work on these guidelines, but the involvement of the principal ensures that the brand comes to life in a way that supports its core values and overall goals.

5. Launching Growth Strategy

The baton is almost passed.  The principal doesn’t need to be involved in every aspect of planning the fertility company’s growth strategy, but they need to be the one to commission it’s execution. 

The principal must see and approve the plan before execution begins. Even when your team is fully incentivized to move towards the company’s growth goals, the principal must ensure that execution of the plan is underway before she or he can step away.

6. Operational Overlap

When you look at the Four Phases of the Fertility Patient Marketing Journey, you’ll notice that the closer you get to the outcome of getting paid and improving patient satisfaction, the greater the operational overlap.

Without continuity across these areas, there is a sharp decrease in the likelihood of the marketing team being able to complete the desired results. These areas are run by other people, and your marketers are not their bosses.

The principal must remain active until operational, administrative, and financial teams accept their role in the strategy.

When a fertility business’s principal can be uninvolved in marketing

We’re finally at the point where you can pass the baton, take a break from the relay race, and let your team take care of the heavy lifting.

7. Coaching/Management

There’s no need for a fertility business’s principal to be involved in coaching your physician liaisons, call center, patient navigators, or marketers. Their managers are in charge of the day to day performance and outside companies can train your teams, or train your managers to train your teams.

If you participated and led at the points you needed to, you can trust your team to get to work. 

8. Brand Activation

As the principal of a fertility practice, you don’t need to direct the brand assets that engage patients with your company.

You’ve approved your brand book; this is a job for your marketing team — they’re the ones who should handle brand activation initiatives like website design, social media templates, and launch campaigns.

9. Strategy Execution (with one exception)

You don’t need to schedule video shoots, write social media posts, edit blog posts, oversee advertising campaigns, implement CRM or EMR sequences, monitor lead conversion, or report on post consult follow up.

There’s one exception, however. 

If you’re being featured in a piece of content, you need to be available as the star while your team produces, writes, directs, films, and edits.

When the principal of a fertility business should get reinvolved in marketing

Periodic reinvolvement keeps the foundation of the REI practice or fertility company solid and ensures long-term success. 

In marketing you can set it but not forget it. As the leader of your practice, it’s important to check in, reinforce accountability, and ensure that sales, marketing, and operations have stayed true to core values. 

10. Culture

In most cases, I hate calling a company's workforce a family. Employees are most certainly not children and they are not your children. In the specific instance of who models the company culture that everyone else imitates, however, this wisdom from Gabrielle Reese is apt.

“[Children] watch you, they don’t listen to you.”

You are the matriarch or patriarch of your fertility business’s family in this sense. The family follows your example.

Really, culture is the ongoing commitment to your positioning, and the critical element of commitment is action. If you’ve decided that your company is going to be more in tune with the needs of same-sex male patients than any other organization, for instance, your team can only live up to that culture to the extent that you champion it.

11. Brand refresh, redesign, extension

Many fertility companies need a brand refresh, periodically.

Fertility centers that built a brand for Baby Boomers or Gen X-ers need to update because Millennials and Gen Z patients now make most of the patient and donor populations. They respond to different types of marketing because they have different concerns

If you decide to extend your identity with a new brand for fertility preservation or third party IVF, the principal must be involved in the beginning stages of those initiatives. If you are changing the identity of your IVF center or fertility company, even moreso.

12. Accountability of Leadership

Entrepreneurial Operating System (EOS) Accountability Chart applied to fertility clinics

Finally, even trustworthy and capable sales, marketing, finance, and operations leaders need to be held accountable by the visionary and integrator of the organization.

As fertility experience consultant Lisa Duran says, “people do what their managers pay attention to”.

It’s not just about them. Periodic check-ins also demonstrate that you’re holding yourself accountable. Employees don’t need to be micromanaged with due dates and metrics. They should see that the principal is paying attention to the outcomes to which they contribute:

  • IVF cycles

  • Patient Satisfaction

  • Egg freezing retrievals

  • Third-party IVF recipients

  • Third-party IVF cycles

  • Tubal Ligation Reversals

  • Donor recruitment

  • New patients

  • Specific provider volume increase

  • Targeted region/office volume increase

Are you ready for a better relationship with your marketing team?

While you do need to be involved in many aspects of the marketing process, chief executives of fertility companies and REI partners like you also need to be able to free themselves of certain marketing responsibilities. 

Getting to the point where you can pass the baton only happens when someone else is completely in charge of the outcomes that grow the business. Pay attention to these twelve points to know when to lead, when to throttle down your involvement, and when to release.

Letting go can be difficult, though.

That’s where we can help. Get Fertility Bridge’s support in selecting marketing personnel, determining their responsibilities and outcomes, and more with our Goal and Competitive Diagnostic.

122: Attracting and Retaining Embryologists with Dr. Tony Anderson

This week, Dr. Tony Anderson joined Griffin Jones on the podcast to shed light on why there are so many embryologist openings and what you can do about it. He estimates that out of 420 clinics, there are 400 job listings for embryologists. Even if you do find one, how do you retain them? Dr. Anderson gives us strategies that you can implement now to help embryologists avoid burnout 


More from this episode: 

  • How to reduce embryologist burn-out

  • Why there is a huge demand for embryologists

  • How to attract and retain embryologists

  • Best way to train new embryologists

  • What younger embryologists look for in a work environment

 

Dr. Anderson’s Information

LinkedIN: https://www.linkedin.com/in/tony-anderson-d-h-sc-eld-abb-8272a21b/

Facebook:https://www.facebook.com/embryodirector

Website: https://ivfacademyusa.com/

 

Mentioned in this episode: 

Think Again by Adam Grant: https://www.amazon.com/Think-Again-Power-Knowing-What/dp/1984878107


Transcript

[00:00:00] Griffin Jones: Want more embryologists right now? Yeah. You and everybody else. So today I talk with someone who has a plan of getting more and retaining them. His name is Dr. Tony Anderson. He's the founder and director of a program called Embryo Director IVF Academy. Before we get into today's show, the shout out, goes to Dr. Isaac Glatstein in New Jersey who made the connection for this interview. There are topics that you think that I should cover. And people that you think are very qualified to cover them, that the business side of the fertility field should here, please make those intros. I don't always take them, but sometimes I do.

And this was a case that I did. So I hope Dr. Isaac Glatstein is doing really well in my interview with Dr. Anderson, we talk about ways of eliminating some things in the IVF lab, so that current embryology staff are less burned out. We talk about ways of recruiting them some of the low hanging fruit for training and then growth programs so that they stay with you.

And that it isn't just about money. And we do talk about some of the current wages and competition for them in the marketplace. So enjoy this interview on today's Inside Reproductive Health with Dr. Tony Anderson. 

 

[00:01:54] Griffin Jones: Dr. Anderson, Tony, welcome to the inside reproductive. 

[00:01:59] Tony Anderson: Thank you Griff. Delighted to be here and welcome to be here. Thank you. 

[00:02:03] Griffin Jones: It was an REI mutual friend of ours that put us in contact. I was telling you before the show started that I tend to neglect the lab.

And you said that I often talk about a shortage of doctors and I do almost every episode and some, I very often forget to talk about the shortage of qualified embryologists and lab staff. And so that's something that you're working on. Why don't you first talk about what you see is the problem and then talk about what you're doing to solve it.

[00:02:32] Tony Anderson: Well, we've actually seen a large increase and the demand for IVF and fertility preservation of fertility genetics. I always use the example of, we've built our careers on the baby boomers coming through. That's where I built my career on. And today the gen X-ers millennials are the largest generation of the 20th century.

And all of these young people are coming of age and so there's higher demand. And with these young people coming up fertility age, we're not only just treating infertility. We're also preserving fertility. We're doing genetics and, there's a lot of at-home testing that we can do.

So the industry is just really growing. There's more demand for that. 

[00:03:19] Griffin Jones: So when we talk about the demand, that's probably going to increase for some time. Why is there a shortage of embryologist to meet the demand? Why isn't the supply of embryologist grown with the demand? 

[00:03:34] Tony Anderson: It's not a huge, huge career.

We're a very small group niche of people just like REI and fertility nurses. They're just a lot of nurses out there that in general. So we tend to recruit for nursing from other nursing departments, nursing careers, but when you get into nursing, it's, it's a whole new language that we speak. It could be a nurse for 30 years, come into fertility and it's a whole new career. Embryologists are a lot the same way. No one actually goes to school to be an embryologist. A lot of us are pre-vetted or pre-med or biology majors, and just bringing them into the careers, actually recruiting them as the hardest. And in my training program, I'm actually trying to recruit people to train and get them into the embryology career.

And a lot of people just don't know about it. And so going to the local universities, there's also a misconception to believe that you have to have a master's degree to become an embryologist. And that's not the case. You have to follow the regulatory guidelines. You have to have a minimum of a bachelor's degree and a science, a physical, chemical, biological sciences.

 So I'm always trying to recruit these people into the industry and embryology, but if you could go back to the very first IVF baby Louise brown in 1978 .I always like to say we're like a band. You always have the doctor who is Patrick Steptoe. You always have the embryologist who is Bob Edwards, and you have a nurse that was Jean Purdy.

You could just search Louise Brown in anything and you'll come up with those three people. And I always like to say, when you have fertility care fertility treatment, you have to have, the band is like, you gotta have a guitar player, but without the the bass player, the drummer.

It's really not a band. And so you really have to have those three people and, , working with medical practices, there's always the the control tower or the people running the front desk that are regulating the flow. So, it takes the whole group to put it together.

But my focus has really been working on embryology, recruiting them, training them. And I go through a three month training program to get them into the embryology and then help them find jobs. So that's what I'm trying to do, where there's a demand for it and to feel bad. 

[00:05:48] Griffin Jones: Who are we losing people to when there are people that could be great embryologists and they're out there pointing their career, when they're pursuing that or another scientific endeavor in the case of REI, we might be losing other REI to other subspecialties.

Maybe they're going into MFM, or maybe we're losing them a little bit earlier and they're not sub-specializing at all. Or maybe we're losing even some of them a little bit earlier than that. And they're choosing a different line of medicine then obstetrics and gynecology. So what are the other areas?

And I never asked this to Bill Venier or Shaun Reed or any of the people that came on to talk about lab needs in the past. Who are we losing people to? 

[00:06:31] Tony Anderson: It's not so much losing people. If you take the example of the REI. REI has only have so many fellowships a year per year. And so there's probably more demand for REI, then are actually going into the fellowship. And so OB GYN is go through residency. They want to get into a fellowship and some get accepted. Some do not. And, because of that, the demand there, maybe they need to expand that for awhile to meet the demand when I mentioned that we're treating the, this largest generation of our lives. Then, maybe we need to meet that demand now, but then maybe cut it back later, if the demand goes down. Embryologist there's not like a fellowship or residency, and that's kind of what I'm trying to create here. Rather than you don't have to go get a master's degree, it's just bringing them into it. A lot of people graduate. I mean, I've recruited people with biology degrees and they end up, they're working in cake shops and bakeries and lawyer, working in illegal offices, not because that's what they want teach them, they can go out and do something that they really went to college to do originally. 

[00:07:38] Griffin Jones: I want to talk about more, how you're recruiting them. You mentioned that there is no fellowship for embryology, and I believe that one of the biggest bottlenecks on the REI side is the. The fellowship and the fact that there's only 44, we're only making 44 new fertility doctors a year.

Could we be making a hundred or 200 that's for someone else to say, but it is part of the bottleneck. So without that accreditation bottleneck, what is the bottleneck for embryologists? 

[00:08:11] Tony Anderson: Really just getting experienced, one of the things that I see happening in the industry today is people, every lab, every there's 420 labs in the country, and there's probably 400 job openings right now.

And so if you have a lab, 

[00:08:28] Griffin Jones: Repeat that for me, the listener will have gotten it, but I want to make sure that I got to repeat that, please. 

[00:08:33] Tony Anderson: Well, there's, I believe there is around 420 lab laboratories in the country that report to SART. And I would say that there's probably 400 job openings right now. And so if you are going to another center to recruit from that center, there's still a zero net gain in that community.

And so we're really robbing from Peter to paypal and, we're not doing any of the community, a service or justice that way. 

[00:09:00] Griffin Jones: Is that 400 an estimate? That 400 job openings is an estimate Tony, how do that? 

[00:09:05] Tony Anderson: Just about every lab out there is recruiting and I mean, I'm doing some work where, like you mentioned bill and Debbie out in California, like we're working with ovations and the preludes and, helping recruit people for those centers too, because there's such a demand in them. And if someone is leaving one program to go another to another. Just a continual opening for four positions. I dunno if the ad 400 is an accurate position.

I personally when I'm looking for somebody, I tend not to advertise those jobs because , you want to, look for qualified candidates. And I actually, the last four people I've hired, I've actually hired off of indeed. And until recently I've never hired anybody off of indeed usually I, people will come to me wanting to be trained and, and I will work with them. And that's how I'm actually recruiting. A lot of my, my students were, through Glassdoor and indeed. And , sharing what I have to offer. And what's really funny is that a lot of feedback I get is because I offer an ISA and income sharing agreement where students don't pay anything for their training.

 And I offer that because I am confident enough in my skills and that I can train them and get them a position that I I'm willing to take that risk. And then once they get into their job, I work with a percentage of their income until the tuition is paid back. 

[00:10:33] Griffin Jones: A different higher Ed would be if that were model universally adopted. 

[00:10:39] Tony Anderson: Yeah, what undergraduate degree offers that are master's or doctorate degree offers that. And so that's what I'm doing. And when I get a feedback with that is that is too good to be true, like who would do that? But I just know there's enough demand.

And I've been doing this for 30 years that I I'm confident that I can get them a job if they're willing to be moved. I live here in San Antonio. It's where my lab is, there's only like four labs in San Antonio. So if you want to be in San Antonio, that really limits what I can do.

But if you're willing to go anywhere in the country, there's no doubt in my mind that anybody who comes through will have a job when they're done. 

[00:11:17] Griffin Jones: So talk to us about what you were doing before and then how you decided. You knew that there was a demand, but how did you decide that you could meet this market need for training more embryologist?

What were you doing before? And then what was it that got you to leave your day job? 

[00:11:35] Tony Anderson: Yeah, we all, just like anybody, when I left my undergraduate looking for a job. I ended up cloning cows working in the bovine industry early in my career. A lot of us from the bovine world were recruited into the human world.

And worked with some really great people in my career work with Klaus Wiemer, Jacques Cohen, Santiago Munne. Like I had some great mentors along the way. And I always had this euphoric dream that I was going to train my group of people. And I would retire with that group of people.

And over time, as I felt like I was constantly training people. I ended up doing my masters at Leeds University, distance learning program. And my doctorate degree was at Nova Southeastern where, one of our projects we had to do, we actually had to create an educational program. We had to create our own class. And through that, I thought, why not create this, training program through this? And so I started putting it together and just kind of experimented with a few people, not really knowing if it was going to do anything. And I ended up training a few people for free and getting them jobs and they are doing really well in their career. And I actually, one of the my medical director at the time Francisco Ardando, he's like you actually are really good at training people that actually putting it in terms that people understand and not trying to make it sound all flowery and fluffy.

And so, I just started doing it and put it together and put together the program started marketing it and it was really kind of funny. It's kinda like, I thought, well, my reputation, if , people will come, I'll build a website, they'll come. They didn't come. And really that's when I started kind of doing my, booths at the shows and people start realizing that this is a real deal.

And so it was actually training program of the kind in the United States. And I believe there's a couple more, you mentioned bill out in California and bill and Debbie, but yeah, so we just built it up. And in this year I decided to go out full-time on my own and doing this whole time.

[00:13:42] Griffin Jones: So tell me about those booths. Where are you recruiting people from? How are you finding people? Because as you mentioned, a lot of people don't even know that this is a potential career path. 

[00:13:53] Tony Anderson: Yeah, well, I mean, really honestly, it's really kind of getting the trust from my peers. I've been working in the field, so it's a very small field.

We tend to all know each other and basically, there's two types of people like there's people currently in labs and IVF labs. Like I have two people coming in next week. They, are coming in from New York. To train for five days. Those are short-term courses so the, the booths are really that I recently started doing the long-term courses, the three month courses, this past year. And I'm recruiting those. A lot of those people from going to the schools, going to universities, collaborating with some of the bio biology departments and really kind of recruiting from indeed as well, to bring those people in and train them from scratch to nobody from zero to hero.

[00:14:42] Griffin Jones: So the short term courses are people who are working in labs right now. It's IVF centers are sending those folks too. And the three month longer-term courses are for making new embryologists. 

[00:14:54] Tony Anderson: Yeah. The real low hanging fruit for in the centers right now. If somebody wants to, they're short and the embryo lab, like you can train somebody pretty quickly into andrology usually around just, I usually I call my andrology course a five day course, you can do basic semen analysis count motility, morphologies, and then you could do the IVF, perhaps IOI, perhaps usually within five days, you can do that, but it's going to take quite a bit more time for the embryology piece. So a lot of those, a lot of these labs, I think one of the real criminal things that we do to some of our teams is we have somebody in andrology that they've been there for nine years and they are hunger for an opp opportunity to get into embryology and then they don't. So bring those people into embryology. You can always recruit people into andrology and let that kind of feeding your embryo lab. They learn the quality control. They learn how to keep things organized and manage it. And if you make a mistake with sperm, you can always go back and get another sperm sample.

Do you make a mistake with an embryo? You can't go back and make another embryos. So, I always say that the andrology lab is a great way to recruit people into embryology and let me help you get them to competency faster. The real talk real struggle is that is the labs are really so short staffed that they can't find the time to train them.

[00:16:22] Griffin Jones: So let's talk a little bit about that because their so short-staffed, there's a lot of burnout happening in the lab and there's someone on social media. We both likely know that I'm trying to get on the podcast. I won't mention this individual's name because they're not ready to talk about it on the podcast, but on social media frequently talking about burnout for lab staff.

And on one hand, of course, they're being asked to do so much. On the other hand, I don't know what the alternative is. There's that many people that need IVF cycles. And, and so can you talk a little bit more about the burnout and the busy-ness and how do we solve for this at a long-term bigger picture issue, if we're too busy to do anything but cycling right now?

[00:17:09] Tony Anderson: Yeah. Well, one of the things that we also have to recognize too, is who are our employees? Who are these, we're, they're not people like, I mean, I don't want to like in the generational piece, but, people don't always work for money just because you're going to pay him more money.

Doesn't mean that they're going to want to work more for you. And so people, I like a lot of the people we're recruiting the gen Z, gen Y. They would rather make less money and have better quality of life. And, I gotta say like, maybe they have more right than I did. And so when we talk about burnout, one there's just such a demand, I keep hearing these stories about embryologist, making sure demands of like really huge salaries and working seven to three and not going to work a minute more after that, but just saying, it's kind of odd. You can't do that in embryology, you can't go home to the work's done, if you work in a business office, if the work's not done, you can always pick it up tomorrow where you left off, you can't do that in biology. So we tend not to work, regular hours, regular weekends, and then that's where the burnout comes. Cause it's a 365 day a year. And it sounds kind of crazy. A lot of times when someone comes to me, it sounds like I'm trying to talk them out of embryology because it is. There's probably only one industry that demands more of you than an embryologist. And that's the dairy industry because in the dairy industry, cows need to be milked twice a day, no matter what it doesn't stop. And embryology is a lot the same way. One retrieval a week requires seven days worth of work.

And if you freeze embryos, those embryos never go home. You're caring for them every day, the Cryotanks.

[00:18:51] Griffin Jones: So is there anything else we can do except I guess, invest in training programs like yours. Is there anything else to do though when the demand is so high, it's like I get that you want to work weekends and we'd love to offer you more time off, but or have you do less cycles in the course of a week. But we are beyond, we've got a two month wait list for our new patients. And we're trying to cycle as many people as we can. 

[00:19:17] Tony Anderson: That's a great point. And actually there's a book that I recently read. It's called Think Again by Adam Grant.

It's a spectacular book and I think any embryologist medical director, really anybody in any walk of life will get something out of this. And the idea is that just because we've been doing it one way, all of our careers and all of our lives doesn't mean we shouldn't rethink some of those things.

And I'll use an example of, some of the things that, when I first got into embryology, it was very simple. We did retrieval. We fertilized, we transfer, the next day, like literally two days later pregnancy rates were terrible, but as we did more, we added oil culture. We added ICSI, we added genetic testing.

So it's gotten progressively harder and harder over the years. And the way we were able to do more. With less people, as we stopped making our media, we stopped making micro tools. We stopped doing some of the day two assessments, the day four assessments. So maybe there's still some things that we can do, and this is going to be out there in left field.

And some of my peers might think. But maybe we could get away with not doing fert checks because we're doing genomic testing on every single case almost. So if we're not doing the fertilization checks, then, we're doing the genomics. We're going to know if the genetics is okay before we transfer it and I know a lot of programs are stopping the day three assessments. And so with the day three assessments, it doesn't really matter. Most of us are going to the blastocyst and I always say that if you're going to do a day three assessment, it's kind of like trying to pick the winner of a horse race, on the back turn kind of thing.

So if you're going to the blastocyst, the only way to really know anything is to look at the day that you're going to at the finish line. And one of the things that I'm actually encouraging, some of the labs I'm working in is getting some of these embryo imaging, incubators, where we can look at some of them along the way.

Maybe not have to bring them out and just look at them at time when we have the time and hiring people to outsource things that we're not doing, like data entry, emailing the patients, embryologists do a lot. I always say it's about 60% bench time, 40% admin time. You could increase their bandwidth if you took that 40% admin time away and let allow them to work doing what they were doing, but they'd best at. 

[00:21:43] Griffin Jones: Well, whenever anyone is at capacity with anything. The first thing to do is eliminate anything that's possible. You've given us a couple ideas then automate and then delegate or outsource, and even as like a couple of ideas for that. So that might be able to help some folks with burnout temporarily. I want to go back to something you said, because I want to see if you think it's true when you're talking to these new candidates, when you said a lot of the millennial and gen Z are willing to make less money in order to have more time, I hear it all the time. Tony, I had see it in some HR statistics and stuff. I'm skeptical that it's true. I think they want that. I think they want the time that the older generations didn't have and they want the money and they want it.

 That's what I'm seeing when I hire, especially I know the last year or so has been a fluke in the entire job market or a riff, you might say I'm not convinced that it's ever going back to normal. Even if we see a recession, I know things will, sometimes they admin in the favor of employees. Sometimes in the favor of employers, but I really think that this could be the new normal, where six figures is the basement for anything like being a manager at a retail store and anything. And, and they want to work 30 or 40 hours a week tops. And that drives up the real, the market for, for highly skilled labor, like embryology.

And so what are you seeing, when you're seeing these younger folks start to take positions? 

[00:23:19] Tony Anderson: Well, I agree with you can't hire somebody at a base salary and I don't, I've never operated this way. You can't hire somebody at a base salary and expect a 3% a year that, I always use the magical 10,000 hours after you've worked 10,000 hours.

You should be a master of your trade. And so, when you're training with me, I'm going to give you like 400 hours, during that three month timeframe, but you're not going to be an expert till you've done a good solid five years of what you do. I can fully train, I've actually just recently published as submitted a paper for publication on the training and how well it works. But at the end of the day, when you hire somebody, you have to be willing to give them five and $10,000 raise that raises for that first year to get them to where they're at, you have to pay them fairly. And that's where, if you hire someone who's going to use a random number like if you hire someone for $50,000 , straight out of school with some training the program or 60,000, that in five years, you probably need to be up there in that, six figure salary. If you're still paying them 55,000 or 60,000, or even 65,000, they're going to go somewhere else.

So you have to pay them fairly enough. And then also give them, I think with a lot of the younger people, they don't want to be micromanaged. So in some ways I agree you can't. Just let them work from eight to four or eight to three and pay them six figures. But the goal is that, if you think you can get to that point, then they probably will.

When I'm recruiting people, I have a coffee talk with them and just like I'm having, what do you want your base salary? Where do you think you'll be in five years? What what's gonna make you happy? And if you're not, if I can't make those expectations, then I don't want to recruit them into the program.

I actually had worked with the EVMS program for awhile while I was teaching them. And I had one of the students come out and say like, they expected their base, their first salary to be $80,000. And I said, I got some good news. I got some bad news. Sunday you'll make 80,000, but it's not going to be your first salary out of school.

It's you have to work up to that and they if you make a plan for them in the beginning or where they're going to be and where they're going to be in five years and you'll have some loyalty and commitment and not have to make them sign non-compete contracts, I never had anybody have to do that.

My goal is to support them along the way and be there as a director, I also offsite direct labs and that's how I recruit people in here's your growth plan for the next five years? The real challenge is after five years, what are you going to do? That's been my real challenge is after five years and you're not learning as much.

You're not building those skills. And now you have to kind of really drill down as a person, that person that you have hired, how are they going to get better? And at that point, maybe they should consider master's degrees and doctorate degrees to maybe grow in the supervisory level and lab director level.

[00:26:21] Griffin Jones: So is that sustainable though, at a time when people can constantly one up the other with salary, I guess. So even if you were so money motivated you maybe want a greater work-life balance, but okay. I'm either going to be working the same or they're both going to work me like a dog anyway. And all of a sudden this other person across the street is offering me 25% more than I'm making now because their need is that bad.

And they need it now, I guess. How do you maintain loyalty? 

[00:26:57] Tony Anderson: Well, I would say that a lot of these people that are jumping from one place to another, to another, that if I saw a resume that did that. I wouldn't be real hesitant to hire that person. 

[00:27:07] Griffin Jones: If you're so desperate, Tony, like I think some, somebody still might pick up Antonio brown next year for all the football fans that understand that they still might do it.

Even though that is a fire of a resume, but some buddy might be desperate enough to do it. And, and when there is such high demand, I think people will look well, eight months here, a year and a half here. I still see people getting hired like that. 

[00:27:33] Tony Anderson: Yeah, honestly, I actually know people recruiting people that way too.

And I really actually hate to see that recruiting from other centers, you get a bad reputation as a lab director and an organization when you do that. And you have to be real cautious about if you're the one leaving and because I have had peers that they jumped from one program to another, to another, and some large cities you can get away with that San Antonio, you can't because if, unless you want to leave to another city but , say like if you're in New York, if you jump from program to program, you can do that for awhile.

But after awhile, what are you going to do it? And even if they do offer you more money, are you really worth that amount of money? And just because you have a desire to do that. And there's another thing that I also always say, if you don't like where you're at, because of personalities or something like that, then wherever you go, that's where you'll be.

I have another way of putting it, the reason why the grass is greener on the other side is cause it's covered. Cause it's covered in crap. When you get over there, it's the same crap that you're sitting in. So just because you're moving and jumping around from program to program, doesn't mean you're actually worth it or things are going to be better when you get there.

[00:28:45] Griffin Jones: Well, let's talk a little bit about other ways of motivating in keeping embryologist to justify training them because I'm not totally satisfied with the wage prior to my friend, Dr. Eduardo Harrison is listening. He and I had a debate about well, the cost of fertility treatment go up or down.

And in the next five years, I still see it going up. And one of the reasons is I think that the salaries that you mentioned for recruiting people into the field are, are too low. I th when I hear that compared to what I pay my people, and we're a marketing firm, for example, it's like why there's so many other places everywhere across the workforce.

And maybe that will like I said, maybe it will add back to the other way to employers, but it sounds to me, like there might be too much competition that even if somebody isn't money motivated, it's like, wow. Like if I could do this for 30% more, 20% more I think that's a hard thing to overcome, but lets you and I are in solving for that today. One other thing that I want to think about is how do you keep people engaged in a way that justifies investing in them? I wonder if embryology is too boring for some gen Z folks or for some millennials. And the example that I have is I was talking with a junior embryologist who was applying for a position with us.

And I think that they're doing pretty well for themselves and they're in a very busy area. But they wanted to get out of the lab itself. They wanted to stay in fertility. They wanted to work like in a biz dev role in fertility. So if there are lab companies, give me a call, connect you with this person.

But I think that they just didn't want to stand on their feet all day or sit in a chair and be in a lab. All day and this person could, could accelerate a lot more in, in their career and be, and do really well. But they weren't interested. And so how do we either screen for that or help people grow that they actually want to stay?

[00:30:48] Tony Anderson: Yeah, that's those are you bring up some really good points and there's a couple of things that came to mind while asking the question, kind of going back to, people in embryology, one of my challenges was, because it's not cheap, to have an embryo training lab, like I have to have the exact same amount of equipment that an IVF lab would have even more. Because if I want to train more than one student, I have to have multiple micro stations at a a hundred thousand dollars a piece, microscopes. I have to have all of that stuff, liquid nitrogen and embryos. It's very expensive to operate, so it's not cheap to train someone.

And so one of the things I would say, when you talk about cost is not going to go down, but if you're a medical director and you are wanting to invest in your people, when you invest in your people, that means you have a faith in them. You want to keep them there and that's how you're going to keep them engaged, keeping them going to meetings and, investing in them, not just treating them like the carrot in front of the pony and taking them along. But let's just say, if you were to go put $5,000 into training somebody, an Axiom biopsy course now when they come back, when they do for ICSI, or four biopsies. Now you've made your money back every biopsy and ICSI after that, they're going to keep making you money. That investment is going to make you hundreds of thousands percent versus, if you were to put $5,000 in the stock market you might make, if you made 10%, you're going to make $500 a year.

But if you invest in one training course, as you know, two training courses that say $5,000 all year long, every time they do a Biopsy for you, it's making you money. It's the best investment of fertility center can make in their people right now and showing them that they believe in them and showing them that they're going to continue to invest in them and their growth and in hiring people that to, to to help them have this quality of life and, and and to grow in their careers. 

[00:32:55] Griffin Jones: How's AI going to change the work flow that we've talked about in the lab on the clinic side. I've talked about with Dr. Bob Stillman about the possibility of like minority report with the huge screen.

And REI is managing hundreds of cases at once using AI. What is it going to be like in the lab in the next decade do you suppose? 

[00:33:20] Tony Anderson: Oh, well, AI is going to, a lot of people are afraid of AI and a lot of people are afraid of the robotics and a IVF in a box that is going to take our jobs away.

I think it's going to simplify our work and we're, increase our bandwidth to do more. We won't have to manually do the assessments. Everything will be done by the machine, through like Embryoscopes or, MIRI, embryo imaging type incubators. And historically those incubators haven't been shown to make any clinical improvements, but if you can save a safety and time, then those types of pieces will be good.

And people are been able to overlay big data. That'll help you select the best embryo. People like me, who've been looking at embryos for 30 years. We can look at an embryo, back one of my prize, paper nominations. I had a few years ago that I could select an embryo and have just as good a pregnancy rate as a PGT embryo.

And just knowing how the embryo grows. Well, maybe some of the young folks won't have to learn all of those things and that actually make their training go faster. So AI is actually going to be a tool to help us do more with less people. And that's where I see it going and I think we should embrace that.

I think we should embrace the idea of having witnessing systems and bring those into the laboratories to increase safety.

[00:34:40] Griffin Jones: How close are we to some of that? How close are we to AI doing the assessments, for example, and I wait two or three years away from that, do you think it's not on the horizon and you have no way of knowing.

[00:34:52] Tony Anderson: No, it's there now Embryoscope will actually do that now, in there even actually overlaying AI on the genomics testing to take the human variability is out of it. One of the things that is going to make it more expensive because an Embryoscope is a $180,000.

A Casa, computerized assistance semen analysis system is anywhere between 40 and $80,000. If you have a witnessing system it's gonna cost you probably another 50 to $60,000 a year, depending on how large your program is. And so you have to put that cost onto the patient, unfortunately, but with that, the systems, well, if they would all work together that's one of the problems is that, , one company has this system and other company has this system. If they all talked to the EMR, then they would actually be a very powerful system. And so that, really any EMR, if you could get the data to automatically upload into the EMR just like we do with lab core we send a blood to lab core.

All that data automatically goes into the EMR. If we could get our incubators and witnessing systems to do that for us, it would really make life a lot safer and simpler for the laboratory team. We spend a lot of time. It takes a lot of resources to make sure you get it right every time. I always say it's like, when you're going to land on an airplane, a pilot comes in at the runway and if he or she, doesn't feel comfortable with the runway, you can always come back up and come around and do make another attempt at it.

When you're an embryologist, you get one shot at it. Every single time you have to hit that runway every single time. And so these systems are going to actually make our lives better. But it's going to make an investment. Casa systems have been around for 30 years, but you'll find very few in the laboratories because they are very expensive and most docs will be like, well, I can pay that person $30,000 a year versus buying the system for 80,000.

[00:36:51] Griffin Jones: Well now maybe they can't. So maybe that's the tipping point for some of this. So Tony, most of our audience is practice owners or execs for other companies in the fertility field. How would you like to conclude today's topic? 

[00:37:04] Tony Anderson: Well, it's been a pleasure to be here and I appreciate the invite to come and just hope that working, collaborating with the people that are recruiting and seeking embryologist to help them to bridge that gap and to fill that those areas that they need. 

[00:37:21] Griffin Jones: Where can people find you? Where can people find you? And we'll also link it in the show notes. 

[00:37:25] Tony Anderson: My website is https://ivfacademyusa.com/. And my email is dranderson@embryodirector.com. 

[00:37:37] Griffin Jones: Dr. Tony Anderson. Thank you so much for coming on Inside Reproductive Health. 

[00:37:41] Tony Anderson: Thank you Griff. I appreciate you. 

121: Thriving as a Fertility Practice Without Taking Insurance with Dr. Eyvazzadeh

Griffin Jones and Dr. Aimee Eyvazzadeh discuss how she is successfully running her practice solely accepting cash-only patients. The days of losing money due to insurance companies’ refusal to pay are far gone for her. The secret to Dr. Eyvazzadeh’s success is her massive top-of-the-funnel marketing strategy and her efficiency of weeding out patients that aren’t a good fit before she or her staff spends time with the prospect. What matters most in fertility marketing isn’t what most people expect.

In this episode, we cover: 

  • Who would be able to run a cash-only only system

  • How Dr. Aimee has developed a massive top of funnel engine

  • Why success rates aren’t the marketing factor most think

  • Why Dr. Aimee attracts 15% of her patients from out-of-town


This episode is sponsored by: 

Inside Reproductive Health is sponsored by EngagedMD. For technology that educates your patients with true informed consent, visit engagedmd.com/IRH for 25% off your implementation fee. 



Dr. Aimee Eyvazzadeh’s Information:
Company: Aimee Eyvazzadeh MD, Inc

LinkedIn: https://www.linkedin.com/in/aimee-eyvazzadeh-12715932

Twitter: https://twitter.com/_EggWhisperer

Facebook: https://www.facebook.com/doctoraimee/

Insta: https://www.instagram.com/eggwhisperer/



Mentioned in the episode: 

NoHold ( https://www.nohold.com/

EggWhispererSchool.com


[00:00:00] Griffin Jones: Insurance employer benefits can't live with them. Can't live without them. I don't know. Today. I have Dr. Aimee Eyvazzadeh on Inside Reproductive Health. She was on the show about a year or so ago. It was episode 88, if you recall and I just kept asking and trying to figure out why does she have this system for patient attraction of all the content that she's putting out there of this brand and messaging. If she's not trying to scale an enterprise, she would certainly have more patients than she knows what to do with it. If she didn't especially being in the San Francisco Bay Area. Well come to find out. It has partly to do with the fact that they only take self pay patients at Dr. Aimee's practice.

And that's when the light went off. And we talk about the funnel that's necessary today. What kind of market that you have to be in and a couple of other requirements for. Being a self pay only REI practice. Many of you wonder about this and you wonder if, well, I keep getting lower reimbursements on this service from this insurance company, this employer benefits company.

Well, there might be a way for you to just forego that altogether. And I recommend that you listen to Dr. Aimee's take before you do that. So I really hope you enjoy today's show about being a self pay only practice with Aimee Eyvazzadeh.

 

[00:02:12] Griffin Jones: Dr. Eyvazzadeh Aimee. Welcome back to inside reproductive health. 

[00:02:17] Aimee Eyvazzadeh: It's always great to be talking to you, Griffin. Thanks for inviting me back.

[00:02:20] Griffin Jones: If anybody has listened to episode 88 and a lot of people listening now will in episode 88, when I had Dr. Aimee on the first time, I'm just trying to get after, like, I keep asking you questions, like why build a brand like this?

Why build something that is otherwise meant to scale? If you're not trying to scale, like you're not trying to. Open more offices, hire more docs, things like that. And I could, like, I kept grilling you. I was grilling the crap out of you the whole episode, and I still couldn't figure it out why after the conversation.

And then sometime after, like in one of those detective movies where there's a benign clue that set something off and the client's like Washington street that's right. The suspect was from DC. And then he runs back to the headquarters and it was like that when I learned about your. That you are a self-pay practice that you don't take insurance and other types of you know, like the employer benefit coverage.

And I was like, that makes sense. It all is starting to make sense now. So can you talk a little bit about that model and then I'll talk about how I perceive it from a branding perspective with the questions I have there. 

[00:03:32] Aimee Eyvazzadeh: Yeah. I mean, the thing is that I don't own an IVF. Right. And so when you accept insurance, you have to accept the rates that they're going to give you.

And if you don't own the lab, it's hard to carve out the global fee for the physician fee and then the lab fee. So I was taking insurance up until 2013 and then I started paying for my patients, I guess. Because I felt so bad that their insurance was denying the claim on the ICSI. For example, the patient expected that to be paid, but the IVF lab expects to be paid $2,000 for ICSI.

And then I was writing the checks out and I'm like, this is just, it doesn't make sense. Like why would I be paying for people to do IVF with me, I just can't, you know, sustain a practice like that. So then I said, you know what? I have to go cash only. And if people want to receive care for me, they're going to have to, you know, forego the insurance.

And we're so lucky in the bay area like, everyone's my friend here. There's so many fertility doctors. So if there's a patient that really needs to use their insurance, I happily make, I call them warm introductions to doctors that I think will be a really good fit for them after I meet with them and talk through their story with them.

So, you know, I do a lot of, you know, first consults for fertility patients, you know, second opinion consult. And then I just hand them off to a doctor that accepts their insurance.

[00:04:44] Griffin Jones: So it was 2013 that this change happened. Was it ripping off the band-aid all at once? How did you do it? 

[00:04:52] Aimee Eyvazzadeh: Well, it was slowly because obviously you have to give notice to the insurance companies and then it was no new patients with this insurance up until, you know, I could actually, you know, say absolutely no new patients at all with insurance. And it was hard for me emotionally, because I felt so bad saying no to people, especially patients who were well-established who want to come back for, let's say another transfer. That was really tough to say, you can't use your insurance with me, but again, because they could still use their insurance at the IVF lab, they could easily just transition over and I was there to help and guide them. It's not like I abandoned them in any way, but that, that was tough. It was really hard. My accountant was like, Aimee, look at how much money you paid the IVF lab. So you could do cases there. You actually lost money, you know, helping these patients. And for me, you know, there's a good reason why I don't own a lab.

And the reason is I would do everyone's idea for free, literally. Like I would just be like, oh, you don't have to, but now that I know, like I have to write a check for that patient to have IVF that for me, makes it so that I can still run the office the way I do and take care of as many patients as I can take care of.

[00:05:53] Griffin Jones: So how long did that take? 

[00:05:56] Aimee Eyvazzadeh: About a year to go from, you know, well, it was something that I had been thinking about for awhile. And so finally, once I did it, it took about 12 months to get to the point where I can completely just say no insurance at all. 

[00:06:07] Griffin Jones: And what is the arrangement with the lab, like in order to be able to do that?

[00:06:14] Aimee Eyvazzadeh: To say no insurance. Well, it's a facility agreement, just like a surgeon has privileges at, let's say a surgery center for me. I have privileges at different IVF labs and the same fees that a patient sees. It's all very transparent. So let's say one of the centers charges the patient, you know, let's say $3,000 to do an embryo biopsy.

Well, rather than them paying the IVF lab, the $3,000 for the embryo biopsy fee, they pay one fee for their IVF cycle. And then I pay the lab for the services performed base on that. 

[00:06:43] Griffin Jones: Okay. When I've seen the model of not owning a lab before, very often, the person has one lab that they use. And I think, you know, the three or four examples that I'm thinking of, they all, each use one lab. You use multiple lab?

[00:06:59] Aimee Eyvazzadeh: I predominantly use one lab, but the thing is that like, we're all again, like we're all friends here in the bay area and you know, I have patients that, you know, go to another lab because now they have insurance at another lab, but then they want to come back to me and have me do the transfer for them, for example.

Right. Rather than move the embryos to another lab, I can go to that lab and you know, do the transfer for them. So it just makes it easier for the patient. For example, who let's say wants another perspective or, you know, still wants my help after doing IVF somewhere else. And I can still go to that lab. So yeah, I have privileges have many different labs, but it's all just to help the patient and make things harder on me.

But I do it with joy and it's fun for me to just see people and say hi to them again and see how things are going in their lab. 

[00:07:43] Griffin Jones: Yeah. Would this work, if you owned your own lab, would you be able to do this self pay model? And if not, why not? 

[00:07:52] Aimee Eyvazzadeh: I think you could, I mean, if you own your own lab, you can do self pay, but just really depend on where you are, you know, like the demographics in the city that you're in. I'm really fortunate in the bay area, but I'm in a situation where when I make a recommendation to a patient for a treatment plan. Like I think, you know, you're 40 years old. I think you might need two to three IVF cycles.

I think we need to bank embryos. We need to genetically test them. Patients are like, okay, I'll make that work. I'll see what I need to do financially. But I know that there are parts of the country where that's really hard, even for patients to even consider one IVF cycle. So even saying the word a couple thousand dollars can be really a challenge for some people.

So I know I am in a unique situation here. And it's not definitely something for every community, you know, every doctor across the country, but it definitely is something that I've been able to do in the bay area, just because of, you know, the area we're in. And also I do have patients that come in, obviously from out of town as well.

And so they come here knowing, you know, upfront what the cycle fees are here and they're different and you know, in every area of the country, they're going to be a little bit different based on you know, the cost of living in that area.

[00:09:03] Griffin Jones: I don't suspect you'd be able to do that in Akron, Ohio, and that's somebody practices in Akron, Ohio.

I don't know them, but, or I could use any other town as an example. I'm not picking on Akron, but I think my hypothesis is that this works in more affluent coastal cities with very large populations. I had somebody asking me about this years ago, it was closer to when I first came into the field so it was probably five or six years ago. And they're asking me if this was possible, and this was my hypothesis that you would have to be in a really large market. And then you'd also have to be in a, you have to have a wide funnel. That narrows down into that short spout coming out of that funnel, that would be the wide funnel, meaning your, your marketing message attracting people, because you're going to have less people that are able to pass through the bottom of that funnel.

And so it's gotta be wide at the top because it's shorter at the bottom. And I want to talk about that funnel with you and the brand. But I have one question that's probably evidence of my ignorance as a non-clinician, but how do you report success rates in that way if you're using different people's labs? 

[00:10:23] Aimee Eyvazzadeh: I say, if you share with me your age, your follicle count, your AMH and FSH, I'll let you know what your individualized pregnancy rates are. And based on the information that I have about you and I can give that to the patient individually. I don't think it's fair for, let's say a 39 year old with an AMH is 0.1 to compare herself with all, you know, the start data on 39 year olds, because obviously her chances are going to be different.

[00:10:45] Griffin Jones: So that I've think circumvents, a lot of the challenge of success rates to begin with, like the whole controversy around success rates is that you're positioning something like really broadly you're cherry picking data. Everybody complains about what everybody else is posting on their website or how they're choosing.

And, and so it's like, you're, it seems to me like you're avoiding that all together. 

[00:11:12] Aimee Eyvazzadeh: Yeah. I mean, when a patient asks, like where can I find your success rates? I went to start and I don't find you. I say, well, I can't, you can't take the lab that you're going to as a sign of your potential success rate. But I can tell you, you know, just based on the data that I've learned about you, what I think your chances are.

And again, we're so lucky in the bay area. Like every lab here is basically amazing and awesome. So you can't really go wrong with any of the labs around here. 

[00:11:38] Griffin Jones: How often does someone ask you that? 

[00:11:41] Aimee Eyvazzadeh: I mean, my patients are really educated, so those conversations sometimes has come up, you know, maybe like one out of 50 patients will ask me the question.

[00:11:49] Griffin Jones: One out of 50. 

[00:11:50] Aimee Eyvazzadeh: Yeah 

[00:11:51] Griffin Jones: Yeah. That's not a lot. And it was amazing to me cause when I first came into the field, I came through surveying patients. And they talked about success rates in the clarity of success. There was a theme that came up, but like one in 50 is not a lot. And also it's not one of the most traffic pages or the highest converting pages.

There was a discussion about start and marketing guidelines at ASRM couple years ago is the Denver one. And I had my laptop and I opened it up while the speakers were talking. And I went into some of our clients, Google analytics, and it just looked at their most traffic pages and their highest converting pages and success rates weren't in the top 20 for IVF. 

[00:12:35] Aimee Eyvazzadeh: Yes. And I think patients know that it's not so much about what's reported. It's about like how they feel at the clinic. And obviously, you know, that's really important about being heard and cared for, but also like, depending on where you are, some patients just don't have. You know, they don't have a choice as far as like which lab that they can go to because they have to stay close to home for different reasons. So, yeah. 

[00:13:00] Griffin Jones: I don't want to say that it's not important because I've heard patients say so many times about how important is, I'm just sharing what, how the behavior seems to map out from what we can actually measure. And it seems like other things are much closer to the main influence of the decision. So, okay.

So you, well, you have this flexibility to be able to accommodate patients at different labs. You don't own your own lab. It took you about a year to, to wean off of the insurance drug. I think that there's probably a louder, a lot of people list. Well, now you might call it the employer benefit drug too. And that can be a mis-characterized, I mean, there's many people that aren't going to get care otherwise, so I'm not dismissing insurance or employer coverage. I think it's a net benefit for people. So I want to make that perfectly clear. I'm just saying on the other side that I do see providers being the ones to get squeezed very often, they're in the middle of this and I've seen some of the reimbursements that people get and it's like, they're not even breaking even as you said, in some cases. 

[00:14:17] Aimee Eyvazzadeh: And there is one of me, I have 17 full-time employees. I can't survive on insurance with the volume that I'm at, not owning an IVF lab, it's just not feasible at all. So with the amount of time I want to provide, you know, no matter who you are, every patient to me is VIP.

And I want to make sure that I can, you know, provide that level of care without feeling like Costco, like, you know, just so many people coming in and out. I can't give so much of myself if, if I'm doing that, I'm already seeing a lot of, I'm seeing over 30 patients a day as it is. I do all my own scans.

And so I had to do something to, to actually basically limit the practice a little bit as well. 

[00:15:00] Griffin Jones: Why do all your own scans? 

[00:15:03] Aimee Eyvazzadeh: I feel like, you know, I went into IVF or fertility medicine wanting to take care of patients and wanting to do my own scans, my own retrievals, my own transfers. And I feel like sometimes the date of loss in between scans when you have inter observer variability, and sometimes, you know, other people making decisions about, you know, what you should do based on data, not other people, but sometimes the data is not consistent because they're different people scanning.

And I feel like that's always been important. And those are the things that I see when I review records and I can see things like, oh, that's interesting. You can see that, you know, you can tell that different people were doing the scans throughout the cycle. Like I had a patient once and many times where she would find different people scanning her in one cycle and that I think it could have affected her care.

And so that's why it's important to me to scan my own patients. And it also provides that, you know, they hear from me. I have that sparkle checklist. You probably know it, I give them all the elements of what's going on the size of their follicles, the protocol. Am I happy? The lining, when the renewables going to be, with the lining looks like you know, all that kind of stuff.

They'll get that in real time without wondering what's going on. 

[00:16:08] Griffin Jones: Well, it seems to me like you're in a position to be able to make that decision for yourself that doesn't seem like pure efficiency, but that's okay. This is your business, your practice. And you're in a position to make that decision because you're not being squeezed on margins and other areas, or are having to bring in a tech to do it for to be able to pay that bill. So I suspect that there's probably a lot of people listening that envy you, that are in that smaller practice group. And especially like the one to two doc groups that if they're selling to private equity, it's not at a big, multiple, maybe it's enough for them to be happy with retiring, but it's not the same as like these seven doctor groups are getting.

And I suspect that there's a lot of, one to two REI practices, listening that envy you and want to be able to do this, but they're also scared. They think that well I might not be able to meet that. And I might not be able to, to make ends meet that way, meet the volumes that we'd need to do if insurance or an employer benefit company, isn't paying for it.

So, do you see this drying up at all? Do you see on the horizon? I don't think that there's enough cash pay patients out there as employer benefits, increases insurance coverage and mandates increase. 

[00:17:28] Aimee Eyvazzadeh: No, I don't see that. I think there's plenty of patients for all of us and it's never about competition. I don't necessarily see me as someone that people would envy.

I feel like if anything, they might feel sorry for me because I work the number of hours that I work seven days a week. I see patients, Saturdays and Sundays. I'm not taking a single day off this year. The only day I'm not seeing a patient is on Christmas day. And so most people don't want that kind of life.

And so I've chosen that for myself, for my own reasons, just because of just my personality and who I am. But I think most people would like the option to not scan every single patient, but still be able to communicate that with their patients and you're right. They might have that fear that they can't do that just because there is just not something that they actually want to do. Most of my friends were like, I don't want to do what you do. I don't want to see patients seven days a week. I want to break. You're crazy. And I'm like, yeah, I I'll take that. I'll take it as a compliment. 

[00:18:21] Griffin Jones: Yeah. I know that you're a meteorite.

And it's like, when I hear people talk about like entrepreneurs or people that just have seemingly unlimited bandwidth and energy. That's at least how I perceive you. I don't know deeply personally, but I also don't see how you do, like, it's not a requirement that you have to scan your own patients because they're not taking insurance. Right?

[00:18:42] Aimee Eyvazzadeh: No, not at all, but I think patients come here because they want that. They know that they're gonna get that.

You know that they miss that in their last cycle, they missed, like they share experiences where they did an entire cycle and never saw a doctor once. And then they met the doctor that was going to do the retrieval for them. And that's not the doctor that they met at their new patient, 15 minute video call, you know, and so people want that. And so they know that they're going to get that here. So that's why they come. 

[00:19:09] Griffin Jones: Well, staying on the topic of the scans. What's the difference between the physician being with the patient the entire time for their scan versus having a tech do it? And then the physician popping in and saying, oh, hey, catching up for three minutes. 

[00:19:22] Aimee Eyvazzadeh: I mean, it's efficiency. I mean, I can do a scan, communicate with the patient. I actually do my own blood draws. So within like 15 minutes, I can have it all done. The patient feels heard and she's sharing her symptoms. I'm telling her what to do next and I can make the decisions right then and there without any delays.

So I think it's more efficient than having someone do it. I pop in, I say, oh, I'll meet with you the end of the day, we'll have another interaction. It just seems more efficient to doing all the same. 

[00:19:47] Griffin Jones: How many of your patients come from outside of the bay area? If you had to ballpark percentage wise?

[00:19:54] Aimee Eyvazzadeh: A lot. I mean, I think this week I have at least five in a hotel, doing a cycle with me. So if I were to say percentage wise, probably at least 15, maybe even 20% are from of town.

[00:20:07] Griffin Jones: So that has to do with the funnel that you have from the top. They're finding you from social media, from your podcasts, from your mainstream media appearances.

[00:20:19] Aimee Eyvazzadeh: That's right, exactly right. So people seem to like code in the New York times or you know, some other piece you're right on the news of the today show. Then they'll see my name and they'll reach out and they'll do their Facebook research. They'll go into the groups on Facebook and then have people also say, oh, I went to her and then it's more affirming for them to reach out and set up an appointment. 

[00:20:37] Griffin Jones: I should have asked Dr. Eyvazzadeh, if, she uses EngagedMD, because technology making life easier for your patients and making the work experience better for your team is EngagedMD. In a nutshell, you've got a limited amount of time to cover with each patient, EngageMD allows your consults to be more productive.

So you can do what you're meant to be doing nurses can doing do what they're best at you're spending less time answering the same questions. You're then tailor, fitting that time to more educated patients, patients with truly informed consent because enrolling patients in EngagedMD is easy. It takes like 20 seconds.

Then they get some of their time back. The patient that is because they're watching the video modules with their partners on their time. They're completing the knowledge checks with their partners. All of this is sequential. They're signing and submitting. And EngagedMD documents, everything so that your physicians, your nurses, your team members, don't have to get back to doing what should be involved in a technological solution.

Anyway, if you go to engagedmd.com/irh, they will give you 25% off your implementation fee. That's EngagedMD.com/IRH now back to our conversation with Dr. Eyvazzadeh 

So you've got this massive top of the funnel, which I was asked, which is what I was grinding my brain about. The time, we talked on this podcast, why, why? And it makes complete sense because the wider, the funnel that you have, the more you can have mechanisms in place that allow people to self-select, if there's one type of not one type, but if there's a narrower funnel of people that may be able to be a good fit for your model. And we do that with our firm, like Inside Reproductive Health is for everybody. I want everybody to listen to it. I want the drug reps listening to it. I want docs listening to it.

It's mostly practice owners and execs, but I want everybody in the field to pick this up like it's the wall street journal. That a business person reads or watches, Forbes. I want people to watch, listen, to read Inside Reproductive Health every morning. I want this like weekly podcast to be just the beginning and I want to create a lot more content for big top of the funnel, but then I have a very, you know, kind of narrow bottom of the funnel. I don't really have sales calls with people because I don't have a sales team. I don't want to hire a sales team. I have my delivery team. I have people that manage accounts, but I don't want to hire like this entire sales apparatus. So I've got this big top of the funnel, social media, the podcast, the speaking, and then the middle of the funnel is all about our points of view, of how we do things.

And then the bottom of the funnel is like, if you want to engage us, here's this $600 engagement that that allows you to test it out. And I don't really talk with people. If somebody wants to send their marketing director, I don't talk to them to me, that feels like an insurance equivalent of like, no, that's not a good fit for us.

 And, you know, I might talk to a principal for 15 minutes, but it's just about our process. And if they want that $600 offer, that's, if there's no commitment that gets people in and hopefully I've created enough content to help them decide for themselves, if they're a good fit or not. But how do you narrowed down that funnel when you have such a huge top of the funnel? People are seeing you from all over the country. How do you start to narrow it down? Well, We don't take this insurance. We don't take these employer benefits. This is why do you weed that out so that people aren't pissed at you when they're contacting you.

[00:24:29] Aimee Eyvazzadeh: It's simple AI. So I have an amazing AI tool. So for anyone who's listening, who is interested, I work with no hold. N O H O L D. And I'm working on systems to automate many things that are inefficient in the practice. And so we've started with new patient onboarding. So it's basically a virtual assistant that we've created with their help, of course, they actually created it, but all the language comes from me and my assistants here, so that patients at the start of the onboarding process understand what their they're onboard. And for, and their onboarding for an experience with a physician that will not take insurance. And so before, you know, when people were picking up the phone, my new patient coordinator would get all the information and then tell them, by the way we don't take insurance.

Is that okay with you? And you're right. Like, that's not how it should be. So from the very beginning, It's you know, welcome to the practice. Click here. If you want to be a new patient, then the very next thing says, Dr. Aimee does not participate with any insurance companies. It's self pay only. Please click here to continue.

And if you don't want to continue, we send you a really nice message about my IVF classes of courses. EggWhispererSchool.com is where people can go. So if people don't want to engage. Like formally through being a patient, you can certainly take one of my classes that I do on IVF or egg freezing or fertility testing.

[00:25:52] Griffin Jones: So are they seeing this only after they contact the practice or is there some content that you put out in different forms? 

[00:26:02] Aimee Eyvazzadeh: Yeah, so it's we actually don't do any consults without patients going through the website first. So if someone were to call the office, we would simply say, please go to the website and click schedule a consult, and then they'll find the information right there.

And then they can continue the process. It's about 10 to 15 minutes of questions that they answer. And then my new patient coordinator will get them into the portal, send them all the forms they need to sign and get the medical records and schedule appointments.

[00:26:28] Griffin Jones: This is another benefit too. That's another bottom of the funnel requirement that I think people would love, but the top of the funnel isn't big enough.

And this is another way of looking at why you want the top of your funnel to be larger. So most people today are busier than they have been in years. They have more new patients that they know what to do with in 75% of cases. If you have a wider funnel, the wider your funnel is the tighter, you can make the, the requirements of the middle and the bottom of the funnel.

And for most people, I think that they would love that if their patients had, to do that before they scheduled a new consult, but they don't feel like afford the attrition for those that wouldn't do it. 

[00:27:24] Aimee Eyvazzadeh: Yeah. And you can include even insurance, you know what I mean? It's not just using a tool like this isn't just for people who are like me, you can use it for insurance and then it would capture the insurance information right away. And then it could, that information can go to the insurance. The insurance folks in the office that, you know, check benefits and tell the patients with their benefits are before they come in to prevent again, that the hard part of having insurance is when you get to the clinic and then you're told something that is different than what your insurance told you, and then there's issues surrounding that.

But, you know, I'm so lucky that I don't have to deal with anymore.

[00:27:57] Griffin Jones: So there seeing this, which in the no hold was the AI? 

[00:28:02] Aimee Eyvazzadeh: Yeah, no hold,is the company that I use. Yeah. So they're the one that set it up and they're working on onboarding other clinics as well. 

[00:28:08] Griffin Jones: And so that's still at the bottom because of the funnel, because that's when people are contacting you, do you have it in like the middle of the funnel?

Like the videos that you do or do you let people know, even before they contact, we don't accept insurance?

[00:28:21] Aimee Eyvazzadeh: No, it's not something that I advertise or talk about on my podcast because my podcast is really for, you know, education for everybody, for the masses. I don't put it out on my blog articles, like in asterix, by the way, Aimee doesn't accept insurance.

It's just something for patients who are ready to meet with me, then they can get onboarded and they'll find out at that point.

[00:28:43] Griffin Jones: Do you ever get people that are pissed at that point? 

[00:28:48] Aimee Eyvazzadeh: I haven't, I mean, if they're pissed, they don't let me know. I mean, certainly they're sad, you know, sometimes people contact me through Instagram for example, and they're like, do you take my insurance?

And I say, no, I don't, but I'd happy to give you a second opinion on your case. And then I'm happy. to like do that warm intro with a doctor in your area that I feel like would be best suited for you or but I've never had anyone get pissed at me in space. I mean like, no. That is no.

[00:29:13] Griffin Jones: Yeah, it must be my face.

There's a lot more easy to get pissed. And maybe it's the beard. Maybe it's maybe it's the, the hair. I don't know, but I do getting people basically to go from the top of the funnel, to the bottom pretty effectively. And that could have your, you were joking, but it could have to do with your persona. Maybe I know that we've had to invest more in the middle of the content because sometimes it do get people pissed at me when they're reaching out.

And they're like, and it tends to come from the industry side more because we serve the industry side and we think a lot of what we do translates to it, but we have definitely, we think we still know more than any regular marketing agency, but we have not built the systems to the degree that we have for practices and so we tend to do, a little bit more consulting upfront, and so it's a bit more expensive and some people are like, well, it sounds like you're just charging to get to know our situation. Like, yes, that's exactly what I'm doing. I charge you to get to know your situation. And I think what you have to do to be able to do something like this, where you are inevitably going to have to turn many people away.

And in your case, you're sending people to other channels that do need care in order to be able to do that. You have to have other places that you can refer to them and have resources for them. So I don't feel bad about turning people away because I put out a hundred and thirty episodes of Inside Reproductive Health and articles upon articles have really in depth points of view on physician outreach systems and IVF conversion systems and things that take me 20 hours to create.

And so I feel like, you know, if somebody is like, well, we think we should just be able to talk to you. It's like, if I haven't given you enough information to decide that 600 bucks or $1,500, then I haven't done a good enough job, but I do have those things to be able to give them for free. And the vast majority of people are understanding and so you have that. So you talked about some of the things that you do, what are some of those resources that you give people when they are in a position where they can't afford to pay out of pocket? 

[00:31:27] Aimee Eyvazzadeh: Well, my IVF classes. So I have a live class every month. I have an egg freezing class, for example, fertility awareness class, like teaching people, what level, you know, what to get checked, you know what to ask your doctor.

So those classes are pretty affordable. They're anywhere from like 30 to $60. And then have my blog and then my YouTube channel and then the podcast. And so, you know, those are the different ways that people can engage with me without paying to, to see me formally as a doctor. I always tell them, obviously that whatever I share with them is not to be considered an expert opinion because I'm just sharing information and not medical advice and soon hopefully in the next, you know, six months, I'll have an app where people can engage with me more formally without the being fully onboarded as a patient. And that might be a price point, kind of like a subscription model where they can get their questions answered. And for me, it's going to be helpful because right now I get questions, there's so many different social media channels, and it's hard. I feel bad. Like, I want to reply to people, but I just can't. Cause I can't go back. Like if I ask, you know, someone will be like, you know, what do you think about this account? Well, I can't engage back and forth with them because I'll lose with the number of messages I get.

I won't be able to go back to that. But with an app, for me, it'll be really nice because I'll be able to track the questions and be able to answer them. And then that would be a really fun thing and hopefully remember the entrepreneurial side of me, you know, I don't plan on working forever. Right. We all end up not being able to work at that mean I'm not planning on dying anytime soon, but this could be something that. 

[00:32:54] Griffin Jones: I thought you did plan on working forever, I thought you are just gonna, do a retreival and then keel over. 

[00:33:01] Aimee Eyvazzadeh: That's probably what's going to happen my grandfather, God, rest, his soul did that.

[00:33:04] Griffin Jones: I remember that story.

[00:33:06] Aimee Eyvazzadeh: Yep. So I, hopefully will not, you know kill over like the Peloton guy. I hopefully won't do that, but you know, that might be something, you know, cause I don't have a practice to sell. I don't think there's much to sell when it comes to, you know, what I do, but that might be something that would have value in the future for somebody.

[00:33:24] Griffin Jones: Well, if you want it to, you could absolutely sell that brand as a huge funnel for somebody. So there's something to sell there. Well, I have that for another topic, but I think that having the subscription model something that's low cost, having all of the free content, including the classes, something that's free is absolutely necessary to do something like that, you do it, we do it. But if somebody contemplating this idea, Yeah, you have to be able to give people something, especially because they're turning to you for something so serious. And so I don't think that you can do this without doing that. I mean maybe you could viably, but I think it would be a liability to reputation.

And also, I think you probably feel pretty crappy if you had to turn people away, completely empty handed.

[00:34:13] Aimee Eyvazzadeh: Right. 

[00:34:14] Griffin Jones: So I still think that some people are envying. I still think that some people are listening to to this thing. And while I wonder if we could pull this off, you talked about how much you're working, but is that a requisite for being a self pay only group. I feel like to me, it seems like just you, like that's just Aimee Eyvazzadeh but somebody could work the same as, as, as they did when they're taking insurance. Right. Or sometimes even less because you would have less staff now, you'd have to have less billing staff and so much less resources dedicated to that. It seems like you could work less. 

[00:34:53] Aimee Eyvazzadeh: My issue is saying no. So I have people like that will reach out today and they'll be like, I just found out my IVF cycle didn't work. Can you get me in for a cycle this weekend? My fear is going to start and I'll be like, yes.

So I can't say no and not work as hard as I'm doing. You know what I mean? It's like, you know, I'm trying to say it's like, that's the issue that I have is if someone needs me, I'm not going to say, well, call me in March and then I'll put you on a list. There's no list with me. Once you're in, you're in and I, you know, once you're my patient, I will get you in right away.

And so that's, the issue is just the number of, patients ask me, like, how many people are you doing IVF at at one time? And I'm like, I don't know. I don't count. I don't think about like, when I'm going to see my last patient of the day, I just like look forward to each encounter and just keep going. And I don't have that kind of monitor in my head.

[00:35:44] Griffin Jones: Does that number keep going up then? 

[00:35:47] Aimee Eyvazzadeh: Yeah. 

[00:35:48] Griffin Jones: It gets more than it was last year than it was two years ago than it was three years ago. 

[00:35:52] Aimee Eyvazzadeh: Yeah, it is. 

[00:35:53] Griffin Jones: Okay. And so for you, it's just squeezing those patients into whatever minutes you have in the day for other people, that's going to look like an increasing wait list.

Which many of them are already dealing with? I think for some people there think, okay, well, is my market big enough? Like the New York, San Fran's LA. Those are the markets where I see this working. I don't think the Fairbank's Alaska's or the Buffalo new York's or some of the smaller markets, but then I'm wondering about the Houston's, the Dallas's, the Charlotte's, the Atlanta's and I think you probably could, if you had the right funnel, especially if, as you say 15% of your patients are from out of town.

[00:36:36] Aimee Eyvazzadeh: Right. And I wake up, you know, I start seeing patients at 6:00 AM. So if I have, let's say my equitable scheduled at nine, and I have patients between nine and 10, I'll just start an hour earlier to see them. So it's not unusual for me to start at 6:00 AM and then I'm not, I don't, I basically don't stop working until I sleep. 

[00:36:53] Griffin Jones: Well, other than that, of your inability to say no, because I think other people would just say, okay, well, let's make that a wait list. And even if we get to that, it's a good problem to have, because it, this wages are concerned that we wouldn't be able to meet the volume without having the insurance or the benefit paid patients.

Is there anything else for people to consider before they jump into this. And one thing I'm thinking about is the debate I had with Dr. Hariton on this show where I see more people doing this because I think that there's too many people that feel that are at a point where they're like, well, this just economically the decision is made for me.

And So anyway, before they make that decision, what else do they need to consider? 

[00:37:40] Aimee Eyvazzadeh: You can't do what I do and own a lab. You just can't. I mean, I couldn't possibly.

[00:37:44] Griffin Jones: Wait the minute but we are in the episode that I asked if you could do this with a lab and you said you could. 

[00:37:48] Aimee Eyvazzadeh: I mean, no, no, you could go cash pay, but you can't do it the way I do it.

You can't see as many patients without cause the lab would take more like it would just be another thing to deal with. Like I'm already dealing with the practice and the HR stuff with employees and hiring and day-to-day stuff. I couldn't also then focus on the lab. And deal with that as well.

You know what I mean? So the reason why I can do this and do it as much as I do is because I don't have the responsibility of overseeing a lab at all. You know, I don't have to worry about staffing the lab and you know, what's going on there because other people who are really good at it, way better than I would ever be, are doing it for me.

[00:38:31] Griffin Jones: I just love people in business that makes their own thing. Like to me, that's what being an entrepreneur is about or a small business owner. They're not exactly the same thing, though. They're on the same spectrum, but the. Ideal of either is being able to craft something that you want. And if you craft something with a huge scale, you have to meet to the demands of the marketplace.

But if you're crafting something, that's, it doesn't have to scale to the entire market. You could say, all right, well, is there a segment of the market that allows me to do exactly. I want to do it doesn't matter if, if it's not for a hundred percent of the market, if I can even craft out 1% or two temper, whatever, it might be just enough to support the vision that I want to meet.

That's what I really admire about different business owners that do that. And I think you are just like, you're the example, the standard of who that person is. So how would you want to conclude to our audience? That is mostly. execs in the field. And a lot of them are practice owners, whether they're thinking about this or whether they've dismissed it, how would you want to conclude about this model of building a practice that self pay and so that you can run it the way you want to. 

[00:39:54] Aimee Eyvazzadeh: I would just say, don't be scared. You know, the patients will come. If you provide the best care, they're gonna find a way to work with you, even if it means not working with their insurance. And so if you care about people, they're going to know, and they're going to feel like they're not going to leave your practice if you make the change. 

[00:40:11] Griffin Jones: Dr. Aimee Eyvazzadeh. I know how damn busy you are and so I appreciate you obliging me to come back on Inside Reproductive Health within less than a year of each other. Thanks so much for coming back on. And I hope people really enjoyed the show. 

[00:40:27] Aimee Eyvazzadeh: Thank you, Griffin. Pleasure to be on hope to see you again, maybe in another year.

[00:40:31] Griffin Jones: It'll be my pleasure.




120: Inside 3 Fertility Business Sales with Richard Groberg

This week on Inside Reproductive Health, Griffin has a conversation with Richard Groberg, a man who helped facilitate the acquisitions of The Sher Institutes to Integramed, eIVF/PracticHwy.com to private equity as well as many other business owners exit their business through rollups, sales and consolidations. A common thread through a lot of acquisitions is that he sees fertility business owners lose out on millions upon the sale of their company because they don’t categorize their accounting correctly. Richard gives his insights on roll-ups/consolidations from a private equity group, and he believes that he has not found a consolidation that has been successfully operated.

This episode covers: 

  • How to get the biggest evaluation of your business

  • How to survive the ‘proctology exam’

  • Why roll ups from a private equity groups haven’t been successful

  • When it makes sense for an owner to sell his/her business

Episode Sponsors

Inside Reproductive Health is sponsored by EngagedMD. For technology that educates your patients with true informed consent, visit engagedmd.com/IRH for 25% off your implementation fee.

Richard’s Information

Email: Richardgroberg@outlook.com

LinkedIn: www.linkedin.com/in/rsgadvisorsllc

Mentioned in this Episode:

Built to Sell book: https://builttosell.com/

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[00:00:00] Griffin Jones: If you're thinking about selling all are part of your fertility company. You're going to want to listen to this episode. It doesn't matter if you have a practice or a pharmacy or an EMR or a lab manufacturing company. You want to listen to this episode with Richard Groberg and you'll probably want to listen if you've sold and maybe you're having some sellers remorse.

Richard gives his framework for. What, how he helps practices and other companies in the fertility field to sell. He's been in the field for many years. And in the past three years, he has helped with, uh, three major sales. So we talk about the. This is an area that I don't have complete expertise in. I've never bought or sold a fertility company.

And so when Richard gives very specific examples, I don't, I might reference a conversation that is particular to an episode. It was publicly discussed on this shell. Otherwise. You know, de-identify whoever I'm talking about, because this is not my area of expertise, why I had Richard on. And if you have a different point of view, you're welcome to come on the show too.

If there's something that said that you disagree with, tell me what that is. And come on the show. The show is an open platform and anytime. I have some money on that talks about some of the challenges or problems with private equity. I'm willing to have somebody come on that talks about the pros of private equity.

We keep this conversation pretty balanced, but if there is something that you disagree with, you're welcome onto the show. And otherwise just enjoy this conversation with Richard Groberg.

 

[00:02:20] Griffin Jones: Mr. Groberg, Richard, welcome to Inside Reproductive Health. 

[00:02:24] Richard Groberg: Good morning. Happy to be here with you. 

[00:02:26] Griffin Jones: You're on because my knowledge of clinical operations go so far. That's why I have clinical ops guests on, and my knowledge of finance goes so far as for my firm. I try to shade in all of the parts of the Venn diagram, where sales and marketing overlap with finance and overlap with ops, but I'll never be a pure ops consultant.

I'll never be a pure finance consultant. When I reach the borders of the realm, I need to talk to somebody else. And one of those people is you, and I don't know why it took me randomly bumping into you in Las Vegas to think I need to have Richard on the podcast, but I'm glad I did. And I'm glad you're here.

So I want to start our segue into the topic with what have you been helping fertility centers for a while, but what have you been helping them do specifically in the last two or three years? 

[00:03:12] Richard Groberg: Well, in the last three years, I've had a couple of different avenues where I've helped fertility businesses.

I've worked on three transactions where fertility, one fertility practice, and two fertility related service businesses have partnered with larger groups and private equity, both to get a partial cash out and also to get access to management resources, to build more depth for long-term growth. I've also worked with smaller practices that were dealing with selling part of their practice to a doctor trying to expand do I open satellites? How do I buy other practices? And most recently, thanks to you. I assisted a fertility doctor who was a minority owner of her practice uncoupled from a corporate roll up group and become an independent practice majority owned by her.

[00:04:08] Griffin Jones: So of the three where you helped sell to a private equity group, where they all private equity of those three, where some of them high net worth individuals, where they all private equity firms that they were selling to, or where some private equity firms and some were networks backed by private equity firms.

[00:04:26] Richard Groberg: Two of the deals were sales of, of related companies that were related to the fertility industry specific practice highway EIV F and ReproTech. Two private equity that was interested in the space. I also helped Boston IVF wanted to rid parts of its original sale to the British group.

That was a large fertility network outside the United States, but had no presence in the United States that would also was ultimately private equity back. But it was a pretty large sort of fertility roll-up. 

[00:05:00] Griffin Jones: So when you get a call, it says, Richard, we're interested in doing this. I'm interested in maybe, maybe I'm interested in exiting or maybe I'm not interested in exiting.

I want to just expand and bring in someone to help with that scale. What is your checklist? Like? How do you start the process to it's a big elephant. So what is the first bite that you take? 

[00:05:25] Richard Groberg: Well, the first couple of steps or a little bit like a health exam for potential fertility patient have to understand the nature of the business, its financial performance, its challenges, its growth opportunities and what the goals are of the current owners.

There are cases where owners want to sell on leave. There are cases where owners want to partially sell, but need access to resources that they don't have for growth or the depth of management. So the first step is a practice evaluation, not, not a valuation, so to speak like a formal evaluation, but assess the health and the goals of, of the practice.

After that is the part that most people who've never been through this before. Don't understand and forgive the terminology, but I've called it the proctology exam on steroids of, it's not as simple as you call up somebody and say, I want to sell and you give them a couple of numbers and they shake hands and the deal's done.

That's where the process starts. They do an extensive evaluation. They do due diligence. They review your contracts, they review your financial numbers and your, your, your pregnancy rates and other statistics. And before you're prepared to do that, you have to get your house in order. So there's a lot of housekeeping to be done to prepare for that, that extensive painful review.

The determined is the price we've agreed to in the terms fair. And am I getting what I think I'm getting from the buyer's perspective? A lot of times these companies, because they're private businesses aren't necessarily prepared for the scrutiny in terms of expenses that you run through the business that most private companies do, that might not remain after a transaction.

And I can tell you all kinds of fun stories about unusual things.

[00:07:21] Griffin Jones: Like the business trip to Hawaii. Shout out to Dr. John Frattarelli. Cause I bet everybody wants to visit Dr. Frattarelli because oh, well that was good. We took the family and we stayed for two weeks, but it was for visiting Fertility Institute of Hawaii.

Is that what you're talking about? 

[00:07:37] Richard Groberg: Oh, yeah, I would give you some examples or the car that you expensed, or the fact that you're paying your mortgage and utilities and all your vacation expenses. And this is an important concept. I had one scenario where a business thought it was making $3 million a year because that's what he saw in his bottom line.

But between one time expenses that aren't recurring. And personal expenses running through the business. By the time we got done evaluating it and recasting their financials to properly reflect those non-recurring and what I call private company expenses, he actually was making $4 million a year. And when a buyer is coming in to pay, I'm picking a number for illustrative purposes, 12 times your profits, that extra million dollars of, of, of profitability that you can substantiate and prove in that particular case, put another $15 million in his pocket.

[00:08:37] Griffin Jones: I've jotted that down because I want to come back to that and get some examples from you. I want to try to go in the order that I'm thinking of you dealing with fertility companies that are in this process, you mentioned the first is, is assessing their goals. One goal might be exiting.

Another goal might be having financial capital to, to scale or to take over some other business side of the operation in those two. What are two different paths for those two different goals? Why are those two goals important? Like why is it important to make a distinction between the two? 

[00:09:13] Richard Groberg: Well, if I'm buying a fertility practice and let's just say it's a three doctor practice and two of the doctors want to retire and go away.

As the buyer, what I'm buying is not as valuable. And obviously the purchase price is not as high as look, I want to partially cash out. But I can't really compete. I want to expand, but I need money to expand. I need access to other resources and I'm going to stay and I'm not going to take a hundred percent cash out.

The business is now more valuable to the buyer and will garner likely a higher purchase price. The two large transactions I initiated and negotiated for service providers to the industry got a very high valuation because the seller was staying and retained a 30 to 40% ownership stake in the business post-closing. He's got skin in the game. So that's an important distinction because at the end of the day, The buyer, if they're buying a fertility practice, the buyer is to a large extent buying the engine and the engine is the doctors running the practice and performing the service. 

[00:10:28] Griffin Jones: So it makes sense that if the seller's staying that the business would be worth more, especially if we're talking about providers and the scarcity of REI's, so it seems like if they're staying, then the practices worth more, but one perception that I have, or at least it seems as like the value is in it, for those that are exiting, like okay, I'm going to, I'm leaving the I'm going to retire in a year.

So whatever happens to the practice, I guess, is the decision of the people taking it over. I'm cashing out all of my equity and for, I guess, what is the upside for a seller staying as opposed to a long-term hold strategy of their asset and retaining all or more of the equity.

[00:11:19] Richard Groberg: Well, let me give you an example.

There's a practice in Utah that recently sold to Boston IVF. One of the doctors was retiring, but another doctor, who's an outstanding doctor, medical director. Who's older, but committed to stay for four or five years. And there's another associate there that practice obviously is more valuable to the buyer because there's continuity there.

But to the seller, he's getting now access to this big corporate group who hopefully will provide services better and less expensive leave in a solo practice can provide, give him access to recruiting and hiring other doctors, give him access to the network and hopefully. Two to three years out when he is ready to retire, his practice is bigger, it's more profitable and his ultimate exit will be at a higher valuation.

We can now slide into a whole other discussion of whether all the past roll-ups have worked and whether people who've sold into them for some future consideration have benefited or not the doctors who sold into Integer Med, it obviously didn't work, depending where you were in the spectrum of prelude.

Maybe it did work. Maybe it didn't work. Doctors who participated in ovation strategy benefited handsomely when ovation did a second transaction with another private equity group, I guess a year and a half ago at a higher valuation. They got a second payday that was successful for them. So there's always the promise of that.

It's no different than when a smaller practice that wants to get bigger buys another practice and they merge. And now the practice that got bought is now part of a bigger practice, theoretically, that could be worth more to that doctor later down the road than if they just gone on their own. 

[00:13:17] Griffin Jones: Okay, well maybe you can be the tie breaker in something that Dr. Andrew Meikle and Mark Segal each said in their respective episodes. And I don't want to paraphrase them too much. So I encourage people to go back to listen to the episodes. If my memory fails a little bit, go back to the episodes. But in each conversation asked about building value up until the end.

And if I'm paraphrasing Mark correctly, he felt that, it's sort of feudal just to keep adding value to the practice, right when it's too late, if you know, you're going to sell within a year and Meikle said, no you should be adding all the way to the end. And from my vantage point, especially when you're looking at that, for the case that you just talked about, we got three doctors in any given scenario, I'm not talking about a particular case.

We have three doctors, two of them are going to retire. One is going to stay. Well, it seems to me that if those, if that one is going to stay has a robust brand, that's attracting more patients. That has a recruitment pipeline that younger staff want to work at especially younger docs want to work at that.

I would want to keep that flywheel moving and invest in that until I'm out for the reasons that you talked about, but where do you fall on the debate of it's too late to add value. If you know, you're going to sell in a year versus keep doing it all the way to the end. 

[00:14:38] Richard Groberg: I, you never stop making your practice a better practice because a deal might not go through.

But I also believe, and I have a very close friend in the veterinary business. Who's been through a number of roll-ups. He operates an independent practice. Everybody wants to buy him. And he's like, I'm three years out when I'm, when I'm a year and a half hour, I need to start preparing so that when I go through that proctology exam on steroids, I'm prepared for the process.

But up until the day you close, you always risk something negative happening that gives the buyer an opportunity to renegotiate. So you constantly want to be making your practice more and more attractive unless you're selling and walking away. But even then again, one of the mistakes people make small practitioners and lots of businesses is they get so focused on the sale process. They lose focus on their business and suddenly something gets delayed and your volume is dropped by 20% and you're not as profitable. And the buyer comes in at the last minute and goes, you know, things have changed a little bit where to renegotiating the price or I'm having a hard time attracting the doctor you need because your practice isn't doing so well.

I mean, if Griffin, if you're walking into a, to a dance and you're looking for a date, I mean up to the very minute you walk in, you want to make sure that your hair is bright and your beard is straight and everything looks good. And there's nothing that gives a negative impression. So that's my view.

[00:16:14] Griffin Jones: So I want to ask you about the proctology exam and if I'm doing Mark Siegel's argument injustice, please listen, episode 100 and Mark if I'm still doing it injustice. You're welcome back on to clarify at any time. Let's talk about the proctology exam. Richard, what does this involve you? You mentioned that as the second step, but you said before the financial house has to come in order.

So let's talk about what that means in order to be prepared for the due diligence. 

[00:16:44] Richard Groberg: Oh, and a lot of industries, not just the fertility industry, private businesses don't necessarily keep their financials expecting third-party scrutiny. They run expenses through the business that are personal. They may not be tracking non-recurring or one-time expenses.

They may be expensing things that are most setups are things that should be capitalized, but for tax purposes, oh we bought this piece of equipment. Let's all expense it in year one. So that that data needs to be cleaned up. So it's ready for the review, from a perspective of a roll up group or private equity, who's going to have banks and financing sources and investment committee approvals to understand the financials and that all needs to tie to your contracts, your ownership structure.

So all of those documents and contracts and historical data and financials need to be ready.

[00:17:42] Griffin Jones: Meeting employment agreements, contracts with vendors. 

[00:17:45] Richard Groberg: Absolutely and again, most people not out of any fault they're operating private businesses. They never expected this. And all of a sudden, someone's at their doorstep saying, I'm going to buy you for 12 times your profits.

They're not prepared for this. And frankly, they don't have the time off and to stop and get prepared for it. And one of my other favorite expressions, if you've never been through this before, you don't know what you don't know about the process, about the descend on you, it can be consuming and overwhelming and you need to be ready for what's about to come.

Because again, it's not so simple as, oh, you're making $2 million a year. I'll write you a check for $24 million. I'll see you at the closing table in a week. 

[00:18:29] Griffin Jones: So with regard to the expenses that you said detract from the bottom line that are necessary for that against a multiple are worth that much more if they're added back on.

So is your advice to not take any of those as business expenses? Or is there another way of accounting for it? 

[00:18:51] Richard Groberg: They're there. I don't want to give away all the secrets, but there are ways to pet to track it or go back and recast it so that you can track it.

And like, for example, again, when a private equity group or roll-up group buys you, they have an independent accounting firm that does, what's called a quality of earnings review, which is like getting a 360 body scan. And if you can demonstrate that, Hey, these are the expenses that were personal or time, and here are the receipts and I can run a report that shows them, and I can provide you the backup to prove it.

And in the contract, they won't continue afterwards. Then you can get credit for. When I was in the animal hospital business, there were practices that didn't record all their cash. And then they'd have a little piece of paper that would show all the cash that got deposited in the account that never went through their POS system or accounting system.

If you can't prove it, the buyer's not going to pay for it. So there are different, I'm not suggesting that you don't do it, but you have to be able to track it and prove it. If you want credit for it in a transaction. 

[00:20:01] Griffin Jones: I don't want you giving away all the secrets, but you do have to give me a little bit of free consulting right now.

Here's the, here's an example. So one thing is because I'm not married yet, we'll be soon, but I'm not yet. I don't. And I've rented and living in different cities. I haven't itemized my own tax returns. So when I do charitable contributions, I don't have anything to deduct on my own tax returns.

So one of the charities that I support is Nuestros Pequeños Hermanos. It's dear to my heart. So many people listening have donated. When I've asked them and I'm so grateful for that. And so one of the things that I've done, you know, for example, is I will have Fertility Bridge sponsor a gala, and it will be Fertility Bridge advertising.

 We'll get the logo on the page and in the pamphlet. And I will invite fertility, doctors, fertility, clients, to the gala with me. So they're at my table and that's business networking. I don't know though that it's something it's not something you would do if someone else was running the business though, right?

Somebody else would pick some different kinds of avenue. So is the advice that I categorize that somehow differently? 

[00:21:10] Richard Groberg: The advice is if you know, now that at some point in the future, you're going to be borrowing money, selling partnering, track it, take the extra time to track it, categorize it. Even if you put it, like, if it's a personal expense and use QuickBooks, put a class code in for P so you can always run a report that everything that's P for personal.

So if you think now that you're going to have to do this going forward. When I work with new companies, if I know they're going to be raising money selling at some point, there are things we do from an accounting and tracking standpoint that anticipates the proctology exam a couple of years out so that you don't have to double back.

And say, okay. Mr. And miss bookkeeper go back and find every personal expense that you've run through the business and reposted with a code so that when we get to that point, you can prove it. 

[00:22:12] Griffin Jones: There's a book called Built to Sell, and I haven't read the book, so I'm not necessarily recommending, but if the audience is curious enough, we can link in the show notes, the books called Built to Sell.

But I believe the value proposition is to business as though you're going to sell it regardless of whether you do or not, that you have that it is a business that someone would want to buy. And that seems like a tenant of that having your books categorized in such a way. 

[00:22:40] Richard Groberg: Well, it's a good book. And again, that is good advice.

 If you've anticipated, you will save a tremendous amount of time, aggravation money and not getting distracted from continuing to manage your business by having to double back and figure all this stuff out at a later date, when you're ready.

[00:22:58] Griffin Jones: When you're helping fertility companies get their financial house in order, what are some of the main booby traps or the most common booby traps that you see when you're, when you're taking the PNL against the income statement or excuse me, when you're taking the income statement against the balance sheet, what are some of the common things that jump out to you?

Like, eh, this isn't right. Or something needs to be fixed?

[00:23:21] Richard Groberg: Well, it's the personal expenses and the non-recurring expenses that aren't tracked. It's I haven't reconciled my bank statement in a year. And my books are an up to date. It's, it's again in the cannabis business where I've done some work and what I used to be in the animal hospital business.

It's not recording all the business, I did. The other area in the fertility business is some doctor owners pay themselves big salaries and show little profits, some take little salaries, and then have all the profits. Well, if you're selling to a corporate group, you're going to negotiate what you're getting paid for your work as a doctor post-closing. So that's one of the other things that you have to have an understanding of and then recast your numbers to accurately reflect the past. As if it was the future post-closing. 

[00:24:12] Griffin Jones: I want to talk more about the due diligence and the proctology exam, but I remember what I wanted to ask you about when we were talking about goals and that was had to do with earn-out.

So is it simply the case of one goal as well? I'm just ready to leave the business or, and one is, well, I'm going to stay , is the case, even if you're going to sell, is there still an earn-out and how long is that typically that I need to stay for two years or I, or a year or three years. And how much of my buyout is tied to that earn-out? And how much should I expect to get in cash? You can talk about earnouts for a little bit.

[00:24:51] Richard Groberg: Let me address that first from the buyer's perspective, if I'm buying a fertility practice unless it's a large multi-doctor practice, a big part of the value is the producers. And if they're cashing out and leaving it's worth less So most buyers want one form or another of incentive. I call it a golden handcuff to incentivize and ensure the continued performance of the drivers of the practice, whether it's the younger doctors who were taking over or the existing doctors. So if, and by the way, I have another line, favorite expressions there.

That's why there are 31 flavors of Baskin Robbins. Well, every roll up group has a different way in which they like to do it. They want you to own part of your practice or have a profit participation or percentage of the revenues above a base or a percentage of the profits of a base. Or do you have stock in the, in the parent company or little, all of the above, you know, elevation, you still own part of your lab and you won't stock in the parent one way or another.

The practice is more valuable to the buyer. If the seller still has an incentive to grow the practice and grow the practice profitably for the bot. So for the buyer, the seller standpoint, if the seller is selling and staying, he wants to participate fairly again. If I, if I sell my, if my business is worth $60 million and I keep 40%, I sell, I take a partial cash now, and I keep 40%.

I want that 40% to be more valuable later on. That was part of the story of every roll-up group Ovation is the only one that's even partially worked with. There's been a profitable partial cash out for others, obviously Integra Med, didn't work and peoples, including mine and residual interest was worth zero.

So you want the interest of the buyer and seller to be aligned one way or another. So that business becomes more valuable. And when I eventually get my next cash out, it's for a higher number than today, because that's why I'm selling to you and letting you tell me what to do and putting your services in place and helping me grow focus, do more.

None of that matters if you're not improving my quality of life and, or making my residual interests more valuable later on. 

[00:27:25] Griffin Jones: We're talking about improving efficiencies to increase the value of a fertility company. When I think of improving efficiencies at a fertility practice, I immediately think of Engaged MD. Whether you're going to sell or not, we talk about how important it is to add value and increase efficiency to the end, to improve the quality of work for your employees and the experience for your patients. That's Engaged MD.

If you go to Engage MD's website, you'll see at the bottom of the homepage, it's like a CNN ticker of different client testimonials that they have saying we took what used to be a 90 minute consult and turned it into a 50 minute phone call. That's because Engaged MD is taking so much of the headache and the manual one-offs that your staff has to do that is not efficient for your staff and not effective for your patients and helps to scale that with their comprehensive ART eLearn  library, they're embedded knowledge checks, they're actionable patient comprehension, insights, compliance tracking, automation, automated patient reminders, video replay. This is just taking the manual labor that isn't efficient for your team to do and scales it to patients through software so that you can customize the time that you have with your patients and that experience to be just about them so that they're educated prior to treatments, that they have true informed consent so that you can deliver what should be delivered in the way that only you can. And they're coming in with a much better foundation. 

Go to Engage Md.com/irh and you'll get 25% off of your implementation fee by mentioning that you heard them on Inside Reproductive Health, or you heard them from Griffin Jones. And please do that if you're doing business with them, let them know that you heard them on the show because it's one of the things that allows us to provide you with more content and to keep giving you more resources like this episode. And we want to do a whole lot more. So please mention that and take advantage of what Engaged MD has to offer, because it's one of the simplest largest upside moves that you can make for your practice in 2022.

Now back to the show.

So for how long, because owning 40% of a company that one built is different than owning 100% of the company that one built and having all of the say. And I suspect that this is where a lot of the problems could come from as well.

I don't own the whole thing anymore. I, but I'm still on the hook for, uh, I'm still on the hook for. Listening to what the new leadership or the new ownership has to say. And I do have a financial stake in, in retaining this 40%, because how long does it, like when, when somebody sells partial, how long does that stay?

For 

[00:30:26] Richard Groberg: every scenario's unique, it depends on whether a doctor is 40 years old or 60 and, and what the goal is of the buyer. So again, every situation is different and unique. I mean, but understand that every private equity group, every buyout group, every roll-up group, no matter what they tell you, their goal is for them to either sell to somebody else at a higher price or go public.

So 

[00:31:01] Griffin Jones: is there typically, is there some sort of. Remaining buyout agreement. I don't know. You know, if you would call that a buyout agreement within the new agreement that, okay, if this isn't happening, the remaining partner has to sell their 40% or those typically in 

agreements, 

[00:31:18] Richard Groberg: Yes there has to be some mechanism for an ultimate exit when a doctor retires or dies, what happened no different than in a group, private practice, whether it's HRC or one of the other groups, you know, when someone's ready to leave retire or die, there has to be in mechanism to buy them out.

And for other people to get their equity, 

[00:31:41] Griffin Jones: do you have to have a mechanism for the evaluation in that agreement as well? So that, you know, well, we say it's worth it Well, I think we grew the value to this, and now my 40% is worth Y when you're saying it's worth X, is that evaluation in the agreement?

[00:31:56] Richard Groberg: Absolutely. I mean, and that's, that's no different in any kind of equity this morning. I was on the phone with someone who was offering me. Equity to join a board of directors. And I said, well, if you're issuing the equity every 

single year, how do we value it? So you have to mutually agree on a valuation methodology, whether it's you have an outside appraisal or it's the last transaction that raised money.

But yes, you have to, you have to button up every open issue so that both sides know what the future holds. 

[00:32:28] Griffin Jones: Okay. So you talked about the roll-ups that have happened in private equity. Can you first, how do you define a roll-up? Is it just any network? Consolidating, I guess consolidating in, in this instance is self-defined because they are moving more practices into their network or company of practices.

 First, can you define, roll up and then we'll talk about some of the things that people have to consider? 

[00:32:56] Richard Groberg: My understanding of roll up and roll out is a roll up is rolling in any business is rolling up other businesses in the same industry, a roll out is a strategy which could be part of a roll up where you're opening De novo locations.

So you might have a roll up rolling out satellites. You might have, you know, there've been some models out there that open new locations, you know Kind Body, which is opening new locations. That's a rollout, but they're, I know they also may be buying practices. So that is a roll-up and it happens, they've been roll-ups in the veterinary industry all over health care. Now in the cannabis industry, businesses are being rolled up. 

[00:33:41] Griffin Jones: So what are some of the considerations that for not just fertility practices, but any company that the fertility field should consider, if they're going to be a part of their being approached by a larger organization that wants to roll them up into their portfolio.

[00:33:58] Richard Groberg: So if I'm the seller it starts with, what are my goals? Am I looking to cash out and leave, or do I want to stay three years or five years? You know, this organ transaction that recently closed, they were looking to be part of a bigger group and have access to resources and have a partial cash out. But it's not, this is a very important point.

It's not just the price and the terms. If you're going to be there the morning after, operating your practice that you built and you've run, but now somebody else has bought you in. You have to understand that you they've now bought the right to make some decisions, to have veto power, to insist that you do certain things certain ways.

And once you get past price in terms, what the relationship is going to be like in the morning after? What are you going to insist that I do? What are you, what am I not going to do? What's your strategy for providing value added to my practice become as important, if not more important than thank you you valued my practice at 60 million. I'll take my check and go home. And the, this industry, unfortunately to date is littered with. Not overly successful roll-up strategies that have had ultimate exits, but why there are a lot of new groups coming in. I'll address that in a second. There are a lot of new groups coming in.

There's a lot of private equity money saying, wow, this industry is growing. Let's do here. What we did in other industries, you asked why hasn't it worked? I'll give you my personal opinion. The driving force of these practices, the doctors, whether it's in the animal hospital industry, where I used to be, or the fertility industry or other industries.

And when you buy a practice that is entrepreneurial and self owned, you're immediately, no matter what anybody says, de incentivizing partially the driver of the business. That's part one part two is. The roll-up only makes sense. If the roll up group creates economies of scale, can we purchase cheaper?

Can we negotiate? Third-party payer contracts? Can we do things that manage for your practice better and or less expensively than you can as an owner operator and to date? I don't want to talk specifics to date there, I don't believe there are many real success stories of people look in the mirror.

Now they're unbelievably fabulous practices like Shady Grove and others, Boston IVF, and others that CNY and Hunting HRC that within their own group have expanded, have centralized certain services have provided value added to their doctor partners. But when. You start getting 5, 10, 15, 20 of them across multiple states that aren't born within a central strategy named me one that's worked in a long term.

[00:37:16] Griffin Jones: I don't know that I can yet, but I would suppose maybe the jury is still out. And I suppose if we had some of them on, they would say that it is working right now and so.

[00:37:26] Richard Groberg: The jury is out and I hope that there are some success stories, because I think that if you can build better, if you can do the accounting better, if you can centralize buying, if you can do that for a solo practitioner and let them focus on running their location and the practice of medicine, it does create value for that practice.

So in theory it should work. 

[00:37:51] Griffin Jones: It sounds like you've got a strong point of view on this, and I'm wondering why haven't they been able to improve the economies of scale? You said that's one of the things that they have to do is their value proposition. I've got, I don't know that this is true in the fertility field, but I did observe something back.

My first job out of college, Richard was selling radio ads. Just here's the phone book, kid, go, go slang. Some radio ads, a hundred percent commission. I did that for five years in my early and mid twenties. And I noticed that it wasn't the McDonald's and the Verizon's and the Geico's. They got the deals because if the large companies, Citadel, Clear channel, Cumulus, Entercom gave those companies deals that would just obliterate their revenue. It was the additional people that got it was, you know, your local driving school, your local jeweler, the scrap dealer. Those are the people that I could cut any deal. I could sell five bucks in O8-O9 during the recession is a particularly egregious example, but I could sell, you know, things that were, should have been a $200 spot for $30. And I could sell the evening spots for five bucks a piece and give away the overnight spots and all of that type of thing. And so I don't know that that's happening in the fertility field. So one question is, is it? 

[00:39:05] Richard Groberg: Let me double back, because I need to amplify at the end of the day, the corporate group needs to be able to generate value above and beyond the cost of its infrastructure. So, and I remember back when I was in the animal hospital business and we had 15 locations, the cost of getting up to 15 of a corporate infrastructure was very high.

When you went from 15 to 30, you didn't need a lot of incremental infrastructure. So you have to have enough infrastructure to provide value added, to pay for that infrastructure and create value for the practices. Otherwise, you're just adding overhead that doesn't create value. The other side of the equation.

And I recently worked with a solo practice that was minority owned by a doctor, that was part of a roll-up group, where the question was, are the fees we're paying to the roll-up group worth the services we're getting the answer was no. Now we have to replace some of those services, but they were doing billing collections.

They were doing accounting. They were running the call center and the doctor right or wrong thought that she could do it better or less expensively for herself. If that's the case, then the roll up fails. But if the roll up can provide those services more efficiently, less expensively than the practice can and add value to the practice in a way that creates incremental value above the cost of that corporate infrastructure, meaning Integra med drowned under its corporate infrastructure among other reasons why Integra med fail.

[00:40:54] Griffin Jones: So is it because is it sometimes because there's redundancy or is it simply because of the inefficiency and expense I could do, I could be doing this myself more cheaply and cheaper and more easily. 

[00:41:10] Richard Groberg: Again, at the end of the day, if you choose to outsource something in your business to a third party, it's gotta be less expensive than what you're doing, free you up to do other things which will add value more than the cost or it's not worth doing.

So if a fertility doctor can let somebody else manage his billing and accounting and it frees he or she up, and the cost of having a third party doing it is less than having your own person doing it. Well, then it may be worth it. But if not, there's no value added because at the end of the day, it has to create $1 more value. Then the cost of doing it. 

[00:41:57] Griffin Jones: You mentioned thatIntegra med was kind of the pinnacle example of all of this. What are things that people should be looking for to make sure that they're not in a similar situation right now, or, you know, if you could have gone back in time three years or however long, I suppose to have people look out for the things that happened in that situation, what would you advise people that could be in a similar situation right now. 

[00:42:24] Richard Groberg: Let me, I'll give you an example. On another industry years ago, when I was in the animal hospital industry, there was a group that had raised money at what I call stupid valuations based on their promise of we're going to buy a hundred hospitals and we're going to add value to them of blah, blah, blah.

And they wanted us to sell our group to them for a combination of cash and stock in their business. And they were going to pay us an artificially high valuation. But most of the pro pro proceeds we were going to receive was in their stock. That was artificially inflated. So my partner then used to say, what makes us think that the stock we're getting at 15 times earnings is going to be worth that five years down the road?

 It's, doesn't make sense. Now sometimes fundamentals don't matter, but fundamentally if you're taking highly inflated stock in whatever business, and then the other is you have to believe in the strategy of the buyer that they'll be successful. Otherwise, again, you know, my partners and I took seven figures of stock and Integra med.

It was ended up being worth zero, you know, had we gone back. If we didn't believe their model, if we didn't believe that they were going to be successful, why would you make a bet in them by taking their they're artificially inflated stock? So you got to believe who you're getting in bed with, again, as I said earlier, especially if you're going to wake up the morning after and have to work with.

[00:44:00] Griffin Jones: When you're talking about, in this case, you're talking about inflated stock, but previously you were talking about the multiple of EBITDA that sometimes people are selling, selling at use the example of 12 and two or three years ago. I was wondering, I was with one of my earlier clients, and I told them that some people are selling at 12 times EBITDA

and they said, no, that's not true Griffin. They did not believe me. I said, it's absolutely true. I'm not saying it's true for everybody. The only times I've seen that high is through like very large groups selling to strategic buyers and you know, and having an established brand and clearly a system in place.

But I think four is like the lowest I've ever seen. So what's common nowadays? 

[00:44:41] Richard Groberg: Well, the market's gotten hot again, because there are groups that have emerged with private equity backing that believe that again, make them buy so big groups that have a brand that have multiple doctors seem to be selling a double-digit multiples in some combination of cash stock or ounce notes.

But again, if you're a one doctor or two doctor practice, you're not as worth as much to the buyer. So those multiples can be four or less. Because again, if you're the buyer and you're buying a one doctor practice, you're taking an enormous risk. And that's why when I work with smaller practices that are thinking about exiting, well, you need to get multiple doctors.

You need to open satellites, you need to buy people. You need to get bigger so that you're more valuable and perceived as more valuable to the next roll up group that wants to come into your market and expand their market share. 

[00:45:41] Griffin Jones: I want to do a whole episode on a topic that I think where a lot of upside is if there is a single doc group.

I actually think that's one of the areas where somebody coming out of fellowship or a young associate doc that is either leaving academic practice or they were at somewhere else for two years. That can make sense for them if it's done. Right? Because if that younger doc can bring in that younger doc is in a better position to recruit other younger docs and they have more time to do it.

And so if somebody vehemently disagreed with me when I was talking about this with them at MRSI. So I want to know if you disagree with, they think there's too much risk in that. But I see huge upside.

[00:46:19] Richard Groberg: If you find like I recently worked last year with a doctor in the Southeast great practitioner, great practice.

He's getting older. He's a solo doctor. He had a young doctor working for him and to sell that doctor equity on the cheap may seem like you're giving it away. But two, three years from now, when they're ready, when he's ready to sell or retire, his practice is significantly more valuable because it's a multi-doctor practice.

That's reduced the risk. You and I have a friend in Florida. We almost did business with a couple of years ago. In the last year he's hired two doctors. He's opened satellites. He's made himself. Instead of being worth three to four times, he's worth six to seven or eight times now when he's ready to cash out.

[00:47:09] Griffin Jones: So, okay. So we're looking at this, you know, if you could be looking at under four, if you're a single doc group, and if you don't have a brand and you don't have things in order, if you do have a really robust brand, you have a lot of docs here. You're talking a well in the double digits of multiple. So I'm still curious, like, do you think my economies of scale hypothesis applies to the fertility? Giving the local businesses the deals, but less so to the McDonald's and the, and the Geico is that one of the things that's hindering economies of scale, I don't know that this is happening at all in the fertility field, but I do see when I look at people in the industry, side's target list, their target lists are all the same.

It's these independent groups that still multiple doctors that are still the, the, the biggest in their market. If it's a mid market or at least the third biggest in a large market, these are the ones that everybody is courting. And so it seems to me like they would have more purchase power, but I could be wrong.

[00:48:11] Richard Groberg: Well, first of all, I want to comment about the lack of supply and demand is such that if there are a handful of roll-up groups with a bunch of private equity money saying, we need to go after this industry that drives up multiples because the law of supply and demand is that there are multiple companies bidding on the same handful of larger independent practices, which is why multiples are escalating now.

And I don't think most of these practices in the long run are worth 10 to 12 times. So I would say it's a great time to be a seller. There are some economies of scale there, theoretically should be some efficiencies of consolidation. I've seen aspects of it work. But again, that doesn't necessarily mean that a smart solo practitioner can't negotiate the same deals, but you only have so many hours in the day.

It's why practices hire practice managers, because that way the doctor can go back and practice medicine, deal with the patients and staff and leave someone else to do what they do better. If they can do it better. And if they can do it less expensively than the value they're creating, if it costs $2 to make one, it's not worth it.

But if it costs $2 to create five, well, then it's worth it. 

[00:49:31] Griffin Jones: What about, I guess if you're, you know, in your early forties and you own maybe half of a group or a third of a group, and you've got a one or two partners, and then there's a young associate doc in there is I, I guess I'm still, we, I asked you a little bit about the, the long-term hold strategy and, and I briefly read a paper from HBR Yales paper about that holding a whole longterm hold strategy is more profitable in the long run. When is it the more viable option if it ever is to just say, you know what, I'm going to own this thing for outright. I'm going to slowly increase the value and be a hundred percent or majority equity owner?

[00:50:15] Richard Groberg: There's no one right answer. But if I'm a 35 to 40 year old physician in this industry or the animal hospital industry, another industry, and I believe in myself and I believe in growing the practice and I have the wherewithal to do it unless I'm lacking something that a corporate group can give me, or I want to hedge my bet.

Why would I sell now? And you know, if you've convinced me that I should sell, and the residual interest is going to be worth much more, three years, I'll answer the question by telling you a story years and years and years ago, when I was buying animal hospitals, I met this guy in Westchester who had the largest animal hospital in Westchester.

He was making a ton of money and frankly, he was under-reporting about a million dollars a year. So he was really making a ton of money. And he said, why would I sell my practice now at five times my earnings, even if I add back the cash, when I'm 40 years old. And I said, there's no reason for you to, until you're ready to retire die, or you told me you eventually want to move to Arizona with your girlfriend and become a professional illustrator.

And he went you're right. Thank you. For being honest with me, two years later, he called me and said, I'm ready to go. So, you know, there was no reason for him to sell. He had plenty of money. He had plenty of growth opportunity. There was nothing that anybody could provide him that would add more value. Now, if someone comes in and says, I'll sell you an I'll buy you at 15 times your earnings, that means it would take 15 years for you to earn enough, to, to be equal in actually does come down to partially a mathematical equation.

And then, you know, our friend in Texas who sold his software company, reached a point where valuations were so high and he needed management help that it made sense, but until it made sense, it didn't. 

[00:52:27] Griffin Jones: Do you want to talk about some of the principles where you've done the deal and then you find out it didn't make sense and now you're unrolling up?

[00:52:36] Richard Groberg: Oh boy. I know we've only got a few minutes. There are a lot of cases where the roll-up group didn't perform the way it said it was going to perform and all those things I talked about didn't make sense. And, and especially for smaller practices, where does it make sense for the roll-up group to have a one doctor practice?

People have cut the umbilical cord and uncoupled. The complexity there is if the corporate group has been doing your billing, your collections, your accounting, your new patient generation, doing all kinds of things for you. You better be prepared to take that back in and manage it yourself and not disrupt, you're doing what Stephen Covey calls keep the most important thing, the most important thing and practicing medicine and running your practice. There've been lots of examples of where it's done. And it is because the corporate group didn't live up to the promises in the eyes of the seller. They didn't get me more doctors.

They didn't grow me. The services they're providing aren't worth what I'm paying for it. You know, I can't get anything done. So cut the umbilical cord. Let me do it myself. 

[00:53:48] Griffin Jones: Richard, this interview has been so much value for the audience. I think they're going to get a ton of value. I want to do a live event with you in 2022, where people can jump on and ask questions.

Are you open to that?

[00:54:01] Richard Groberg: I love to you, you can tell, I've been in this industry since 2001. I have a passion and a personal interest in the industry. You know, I've got lots of friends in the industry. This is an area where if I can answer questions. And help doctors through these different processes.

I love to help. 

[00:54:19] Griffin Jones: There are some episodes that I go back and listen to because I need to get all of that information. I can already tell that I'm going to be an early 2022 at the gym listening to this episode. So hello, future Griff, while your listening to this. Richard how would you want to conclude about the topic of selling a company in the fertility field, whether it's a practice or not any, whether it's a pharmacy or an EMR company or a lab manufacturer, how would you want to conclude? 

[00:54:47] Richard Groberg: Prepare for the process and make sure you have the resources to go through it, to understand what you're getting into and to live with what you're going to face the morning after

[00:54:59] Griffin Jones: Richard Groberg. Thanks so much for coming on Inside Reproductive Health. We'll link to the places where you can find Richard and where are some of those places? Richard we'll link to your LinkedIn in the show notes. Where can people get ahold of you? 

[00:55:10] Richard Groberg: Through my LinkedIn is the easiest place or Richardgroberg@outlook.com.

[00:55:18] Griffin Jones: Connect with Richard. And Richard thanks so much for coming on Inside Reproductive Health.

[00:55:23] Richard Groberg: I really enjoyed it 

No More 'Hurry Up and Wait': 4 Steps to Fertility Business Goal Setting That Speed Up Execution

“Hurry up and wait.”

Far too many fertility companies, practice or not, rush into their goals… only to abandon them when they realize that the strategies required to reach those goals require more work and investment than expected.

Whether they like it or not, all fertility practices are entrepreneurial enterprises. Still, many independent centers don't approach growth like their corporate competitors, who actively set and pursue explicit market goals. Corporate fertility groups sometimes set goals but fail to align their efforts to achieve them.  

When an REI practice is in a hurry to catch up to what competitive fertility providers are doing, they may make hasty decisions that paradoxically waste more time (and money).

Some example requirements of different business development strategies include

  • Reserving provider availability for subject matter expertise for digital content or events

  • Creating content to support an advertising or public relations campaign

  • Scheduling staff to stay late or stop seeing patients early to shoot video

  • Restructuring your call center to fix the attrition of new patient inquiries to consult

These are only a few.  When centers face challenges like these without a committed goal in place, they are far more likely to abandon the pursuit having wasted time, money, and effort. 

Some fertility centers even hire marketing personnel only to fire them in a year when they aren’t seeing the results they expected. 

The way out of the cycle is for fertility businesses to set and commit to (or not) goals in four steps.

Slow down to speed up

While goal setting produces real value for any business, in these four steps, we use examples that companies in the fertility field have to consider.

Stop the dreaded “hurry up and wait” cycle once and for all because when you slow down goal setting, it’s easier to speed up the growth of your REI practice.

The four steps of goal setting for fertility businesses are: 

  1. Opportunity

  2. Priority

  3. Alignment

  4. Resource Allocation

1. Identifying opportunities for REI practice growth 

Fertility specialists have no shortage of ways to grow their businesses — there’s a virtually endless array of services you can provide and demographics you can serve. Growth opportunities you could pursue include

For each potential opportunity, you first need to benchmark your current volume, set a goal, and calculate profitability. 

A basic formula you can use is (Goal Volume-Current Volume)Profit = Opportunity Potential

Using IVF cycles as an example:

Goal of 1,000 IVF cycles with a profit of $4,000/cycle = $4 million

Currently at 500 IVF cycles with a profit of $4,000/cycle = $2 million 

(4,000,000) - (2,000,000) = $2 million opportunity

At this stage, many practice owners look at the numbers and think, “We have to do everything!” That’s a natural impulse. You want to care for as many people as possible and you don’t want your fertility business to lag behind its peers.  

We’re not making any decisions yet, though. Pump the brakes and slow down so that you can move much more quickly when it’s time for execution.

2. Prioritize the ‘infinite’ goals of a fertility practice

Research suggests that having too many goals leads to diminished outcomes. That’s why it’s critical to narrow focus and prioritize. If every goal is the priority, none of them are the priority.

The prioritization calculation has many moving parts. In order to effectively prioritize, your practice needs to:

  1. Rank opportunities by profit potential using the calculation above.

  2. Estimate effort--goal against current capacity Does the goal represent unmet capacity that the practice can easily meet? Or, will you need to add more doctors, staff, office space, or equipment to your business?

  3. Subtract effort from goal. You may be able to pursue a more profitable service, but how much effort will it take to reach that goal?Ex: a practice wants to pursue fertility preservation instead of IVF, because of a higher profit margin. If their practice isn’t positioned well, or in a challenging market for egg freezing, filling out IVF capacity may be the quicker win.In addition to helping you rank priorities, estimating the effort of achieving a goal reduces the likelihood of wasting time, money, and effort by abandoning it.

  4. Consider your mission. You are a clinician first and a business person second. If  your personal practice is about advancing fertility preservation, serving LGBTQ+ patients, or treating recurrent pregnancy loss, that has to impact which goals you prioritize.

  5. Weigh brand/market liabilities, particularly strengths and weaknesses in the marketplace. If your practice doesn’t make a move on a certain opportunity, will a competitor take it over and make it difficult for your business to get back in the game? Will it make your brand appear antiquated if you don’t pursue?

You might worry that other goals will be ignored if you choose a single priority to focus on first, but that isn’t necessarily the case. Other areas of the practice almost always benefit from a snowball effect.

Goal Snowball

Here’s an example of how prioritizing one goal can benefit others. Let’s say an REI practice has ten physicians with very different workloads:

  • Two or three REIs have a higher than normal capacity and they have met it. They each do more than 300 retrievals per year.

  • Five REIs are each at a normal capacity of 180 retrievals per year.

  • Two or three physicians are below 150 retrievals per year so they are a financial and access-to-care constraint.


This group has many goals, but they have ranked specific provider volume as their biggest priority. As a result, they:


  • Streamline their call center to balance waitlists. They achieve their highest priority of increasing the volumes of the lagging physicians

And

  • Progress toward their goal of increased patient satisfaction because they have improved the early interactions between practice and patient.

Prioritization doesn’t mean you’re ignoring the other goals of your fertility business because it maximizes the effectiveness of your resource allocation.

We’ll discuss resource allocation shortly. Before we get to that part, though, all of the practice’s partners must be aligned on the priorities.

3. Aligning your partners with the goal (and each other)

Even when the managing partner of the fertility practice or the chief executive of another fertility company has final say, alignment with the partners is crucial.

The fact that partners need to achieve alignment doesn’t mean they don’t already have a healthy relationship, though it can. It simply means that they must be explicit and clear about an initiative so that everyone can come to a mutual agreement.

When everyone is on the same page, it’s much easier to work through any obstacles and questions that arise in the process of reaching a goal.

When it comes to aligning a practice’s partners, third-party support is often the most effective and efficient way to reach a consensus. This isn’t about moderating for conflicts, necessarily — it’s about

  • Prompting necessary conversations that are easily put off when everyone is focused on a new goal.

  • Bringing new ideas for partners to consider.

  • Acting as an objective sounding board in discussions between partners.

4. Resource allocation: Time or money?

The goal snowball means that the strategies required to meet different goals often overlap. It doesn’t mean they’re completely imbricated.

The amount of overlap will vary based on your available resources:

  • With more money, you can plan and execute multiple strategies concurrently over less time.

  • With more time, you can sequentially plan and execute more strategies for less money.

The goal snowball allows for a progressive return on investment. That means you can continue to invest in your fertility business without decreasing your income.

How will you set goals for your REI practice or fertility business?

Before investing time and money on a plan to achieve a goal (not to mention the execution), slow down so you can speed up:

  1. Quantify opportunities

  2. Prioritize them

  3. Align the partners

  4. Allocate your resources accordingly

If you would like outside expertise and experience, we can help. This four-part methodology is part of how Fertility Bridge helps fertility practices and other fertility companies navigate their biggest business challenges.

If you’re ready to set and accomplish goals for your IVF center or fertility company, sign up for the Goal and Competitive Diagnostic here.



119: The Catch 22 of Opening a New Fertility Clinic

In this episode of Inside Reproductive Health, Griffin tackles the challenge of opening a brand new fertility center. Griffin explains the five  operational and five marketing phases you need to work through before opening up your new center. It is certainly not a perfectly linear process and will come with a different set of challenges, but going through these phases will save you time, money, and stress. If you are considering starting a new clinic or in the infancy stage of your fertility center now, this episode is for you.

In this episode you’ll learn:

-> 5 operational phases of launching a new center

-> 5 marketing phases of launching a new center

-> Understanding how to assess the risk vs. investment of starting a center

-> Whether or not launching a new center is right for you

If you would like to learn more about these phases after listening to the episode, check out our blog post, where we go more into detail! https://www.fertilitybridge.com/inside-reproductive-health/the-catch-22-of-opening-a-brand-new-fertility-center-and-the-5-phases-to-escape-it


Inside Reproductive Health is sponsored by EngagedMD. For technology that educates your patients with true informed consent, visit engagedmd.com/IRH for 25% off your implementation fee.


More On Engaged MD:

This overlay of the operational sequence in the marketing sequence is probably the perfect time to talk about our sponsor Engaged MD. Because if you're any fertility center, you want to have a competitive advantage in serving your patients better and improving work-life for your staff. But if you're starting a brand new fertility center, you really want them.


And Engaged MD  is one of the simplest investments that you can make with the biggest return for improving the patient experience and improving the workflow for your staff because Engaged MD allows you to have true informed consent and to have pre-treatment education through technological solutions through software.


This is one of the most innovative platforms in the field, in my opinion. The reason why I have that opinion is because I hear from practice owners so frequently how much they appreciate Engaged MD. And when I did that first sponsorship read people, emailed me to say it's so cool that you have Engaged MD as a sponsor.


We started using them six months. Yeah. We love them. You have a limited window with patients in order to make that impression in order to be able to serve them. And when they're a deer in headlights, when you have to do something that should be procedural or general, you lose that time and that opportunity to build rapport, to better educate them, to tailor, fit their experience.


So. It's the best standard of care for them and with Engaged MD, whether it's there, whether it's medication teaching, or injection teaching or any of the other pre-treatment education modules that they're going through through Engaged MD, they can do it at their pace. They can do it through a sequential model.


They can, they come in educated, they come in having true informed consent so you can tailor fit that experience to them. So if you are a brand new fertility center, in my opinion, you have to have Engaged MD when you launch. And if you're one of the few groups remaining that isn't using Engaged MD you're behind, this is one of the areas where you will see.


An improvement almost immediately. So go to engagemd.com/irh. You'll get 25% off of your implementation fee by mentioning that you heard them on Inside Reproductive Health, or that you heard it from Griffin Jones. Please do that because one, you'll get a couple bucks off. And it helps us to continue to grow the show and bring you more content.


And the immediate benefit is in using Engaged MD  go to engagedmd.com/irh.


THE CATCH-22 OF OPENING A BRAND NEW FERTILITY CENTER AND THE 5 PHASES TO ESCAPE IT

Staffing. Construction. Leases.

Successfully opening a new fertility center takes months of meticulous planning. Then you actually have to launch it into the marketplace. But when? And what if you can't?

In the last three years, Fertility Bridge has advised seven aspiring fertility centers prior to market launch. Only one of them opened on time.

The other six faced delays of three months to two years, and some decided against the idea altogether.

Owners of brand new fertility centers struggle with an inherent Catch-22 in the timing of their go-to-market strategies.

Invest in strategy, content creation, customer service systems, and advertising only to have your opening date pushed back indefinitely

OR, equally bad

Have only days or a few weeks to create everything you need for a full pipeline of new fertility patients.

The Catch 22 is a result of a concentration of risk and investment. I’ve separated the operational sequence of opening a fertility center from the sequence of launching it in the marketplace. To solve the Catch 22, we have to be able to distribute the risk and investment across the sequence at the correct corresponding phase.

The 5 Operational Phases of Opening a Fertility Center

The operational phases aren’t my area of expertise, but as far as I can tell, IVF centers face opening challenges in this operative sequence:

  1. Market selection
    Choosing the geographic market, funding sources, and partners.

  2. Lease or purchase

    Real estate sales fall through right before closing. Landlords don’t include something in the lease agreement that was important in the discussion. A physical or zoning limitation is revealed at the last minute.

  3. Construction

    Even when you lease space in a ready-to-go medical office building, it’s likely that you will need to remodel the plan for your IVF center. You were going to put your collection room on the other side of the lab? Turns out there’s a multi-split HVAC system that connects to the outdoor unit from there. Call the architect. Again.

  4. Staffing

    You’re likely not opening a new center without a few saved numbers in your phone. But how many of them are certain to be the Renee Zelweger to your Jerry MacGuire? Lab Director, Nursing Manager, Office Manager? Then you have to negotiate their salaries, start dates, hire their direct reports, write their operating procedures and train them.

  5. Compliance

    You need insurance (malpractice, liability, worker’s compensation), tax certificates, a payroll executor, an IT/communications provider, EMR, billing software, scheduling software, practice management software, compliance training (OSHA, HIPAA, CLIA, Stark). Each of these requirements comes with the possibility of delay.

I can’t offer much insight into the operational phases of opening a fertility center. I can sequence the Fertility Center Market Launch into five phases to reduce your risk and progress your investment in a successful business in the fertility field.

Below I've outlined the Five Phases of the Fertility Center Market Launch — a tactical approach designed to help you circumvent the Catch-22 of opening a brand new fertility center.

The 5 Phases of Fertility Center Market Launch

  1. VIABILITY

    If you create a successful fertility business, you will spend millions of dollars in expenditures, maybe even in your first year. Before you do, spend a fraction of that investment assessing the total investment requirements of your plan.  The viability assessments come before you make your final decision to start your venture, but before you create a go-to-market strategy or secure a location.  

    At the time of writing, Fertility Bridge helps with part of the marketing analysis for just $597. You'll also want to hire good operations, finance, and compliance consultants. I can recommend a few of them. In total, you should expect to invest a couple of thousand dollars to make an informed decision about moving forward with your venture or not.

    You paid handsomely for a worthwhile education in medicine; consultants are sometimes your highest yield education in business. You can't lose here. Either you move forward with a more educated foundation, or you abort the idea, and you've saved yourself a fortune in time and money by making your decision at the right time with the right information.

  2. POSITIONING  

    While you assess the viability of your practice, you have to consider the positioning of your vision before you commit to bringing it to life. It’s called positioning because it sets your brand, company culture, and growth goals. These are the first steps in establishing your brand identity, so if your positioning doesn’t excite you more than the anxiety deters you, do not start the company. Decide your positioning while assessing market viability. Do this before developing the rest of your brand, creating a marketing strategy, and buying or leasing a location.

    •Core Values
    •Main Focus
    • Ten Year Target
    • Three Year Picture


3. BUSINESS DEVELOPMENT AND MARKETING STRATEGY

Congrats! Your vision for your practice is viable in the marketplace. You are excited about the position it will occupy, and you’ve made a down payment on the facility. Now that you’ve reached the point of no return, it’s the right time to craft the marketing and business development strategy for your first 18 months in business. Your strategy includes your systems for the various points of the Four Phases of the Fertility Marketing Journey. You begin creating your strategy as soon as you start construction or remodeling. If done correctly, it should take about two months to craft your marketing and business development strategy.

  1. If opening is delayed, you don’t have to invest in deploying the strategy. That comes later.

    What if remodeling is minimal and there are no delays? What if you’re already compliant and you have a burgeoning payroll, and you need to start seeing new patients within weeks or even days in order to meet your financial obligations?  

    The third and fourth phase of the Market Launch is where the Catch-22 is most acute. Under increasing financial pressure, many practice owners fall behind. That's when they get into trouble.

    4. IMMEDIATE MINIMUM IMPLEMENTATION

    Here, we break up the concentration of risk and investment to reduce your risk and maximize your long-term return: do not rush the formation of your strategy. Implement the bare minimum in the meantime.

    It doesn’t matter if construction is delayed. These processes, content outlines, advertising strategies, and brand development aren’t just for acquiring new patients. They convert inquiries to consult, consult to treatment, and measure and improve patient satisfaction. They inform who you hire, for which outcomes they’re accountable, and how you train them.

    Remember, three months is a liar’s six months. The timelines that agencies, marketers, and freelancers estimate are often half or a third of how long it really takes. Sure, a monkey can get a website up in a week. The site you really want, with your developed brand and content that represent your points of view, probably takes six months.

    So why not just be honest about that and separate what you need at this very moment from what you need for the foundational health of your fertility center?

    Open your patient acquisition pipeline without sacrificing the planning of the long-term productivity of your fertility practice by covering these four bases:

  1. Initial brand assets (name, logo, colors)

  2. Home page

    Let them know your positioning statement, method for scheduling new visits, and that you can’t wait to show them your new brand and website later in the year

  3. Digital real estate

    URL, social media accounts, and local listings of your brand name. You’re just claiming the real estate here. The only content you have to create at this time is a similar message to your homepage and the documentation of your opening journey if you so choose

  4. Google listings for providers and practice

Implement the minimum after you put a down payment on a facility, while you work on your strategy, but before you start seeing new patients.

5. DEPLOYMENT OF STRATEGY

Time to start delivering care according to the standard you’ve envisioned! 

When fertility centers rush to the fifth phase of Market Launch, they sometimes make errors that take them years to fix. The most common of those errors is hiring full-time marketing personnel. Depending on your growth goals, you may indeed need marketers on your staff. You don’t need them right away. In the beginning, your needs are too varied for one person, and it isn’t cost-effective to build an in-house agency. The time needed to build a new patient pipeline is shorter than the learning curve for someone who’s never done it for a fertility center before.

You deploy the rest of your marketing and business development strategy only after you are ready to see and treat new patients. This is when you film the videos, write the content, produce the referring provider assets, roll out a Customer Relationship Management software (CRM), and hire marketing staff.



ESCAPE THE CATCH 22 OF LAUNCHING A BRAND NEW REI PRACTICE

New fertility practice owners might think that their marketing strategy must be 100% in place on day one — or worse yet, they rush to create one and miss the foundational advantage of setting up their practice the right way. 

Separate the operational phases of opening a new fertility center from the five phases of the go-to-market launch. Break up the concentration of risk and investment by distributing them across the sequence at the right phase.

If you’re thinking about launching a new practice, you might consider our introductory engagement which is only $597. If you would like Fertility Bridge’s help with assessing the viability of your fertility center’s market launch, and our framework for your opening sequence, start here with our Goal and Competitive Diagnostic.  

118: Clinical Operations Meet Marketing

Today’s conversation between Griffin Jones, Dr. Milroy, Dr. Supogay, and Dr. Yanni explores the overlap between clinical operations and marketing. The fact of the matter is, you cannot totally separate them. More often than not, when our clients first come to us, they aren’t able to fit more patients into their system so we first have to work on clinical operation efficiency before driving more patients through the door.

In this episode we explore:

  • The REI bottleneck and how to optimize your REI’s time

  • Referral patterns from other professionals in your community

  • How patients choose an REI

  • Why OBGYN education improves the quality of patients

Inside Reproductive Health is sponsored by EngagedMD. For technology that educates your patients with true informed consent, visit engagedmd.com/IRH for 25% off your implementation fee.

Guests:

Dr. Milroy:

LinkedIn: http://linkedin.com/in/colleen-milroy-37a45ba1

Colleen Milroy, MD, FACOG is a board-certified Obstetrician gynecologist, and board certified Reproductive Endocrinologist and Infertility physician. She currently leads the Billings Clinic Reproductive Medicine group serving the state Montana, parts of Wyoming, North Dakota and South Dakota.

Dr. Supogay:

LinkedIn: http://linkedin.com/in/anna-sapugay-md-facog-66932714

Anna Sapugay, MD, FACOG is a board-certified obstetrician gynecologist who practices in Northern California's East Bay Area. She currently serves on the Compensation Committee, Strategic Oversight Committee and Anti-Racism Working Group. Sutter Health is a not-for-profit healthcare delivery system that operates 24 hospitals and over 200 clinics in Northern California.

Dr. Yanni:

LinkedIn: http://linkedin.com/in/leanne-yanni-md-9b6117194

Dr. Leanne Yanni serves as Vice President Medical Affairs, Richmond Market, Bon Secours Mercy Health and the Chief Medical Officer of St. Mary’s and Richmond Community Hospitals. She is board certified in both Internal Medicine and Hospice & Palliative Medicine.

Website:

https://www.hsph.harvard.edu/mhcm/


Transcript

[00:00:55] Griffin Jones: On this show, it's half me interviewing my guests, half them, interviewing me. I'm not going to go into their intro and bio here because I do that a little bit in the beginning of the conversation, and then they introduced each other, but they're three different MDs in three different areas of medicine that are also in the MBA program at Harvard.

And. In today's show, we talk about OB GYN, referrals, OB GYN, relationships. There's some really good insights for you there. The show is really about where the nexus of clinic operations and marketing come together. There is a place after the overlap where I can't go any further and these three could, and there was a part where they wanted to go deeper in terms of using marketing to set up.

Client operations and I was able to go there. So I hope you enjoy this. This is the nexus of where the bottleneck of the REI field is addressed, where clinic operations and marketing come together. 

Doctors Yanni, Sapugay and Milroy, Yanni, Anna Colleen, welcome to inside reproductive health. This is a little experiment that we're doing sort of on the fly. These are three MD MBA. Students at Harvard and Dr. Milroy, I know through the field of reproductive health and they are interviewing me about a project that they have.

If I can provide some insights, that's the reason you're listening to this podcast episode. And if you're not, it never made the light of day. You're my podcast editor throwing this episode in the garbage. So Dr. Yanni, Leanne, tell us a little bit about the team that you have and the venture, your.

[00:02:48] Dr. Yani: Excellent. So I'm Dr. Yanni and I'm an internal medicine doctor at Bon Secours Mercy Health in Richmond, Virginia. And we have my colleagues, Colleen Milroy, who is a fertility specialist in billings clinic in Montana. And Anna Sapugay who is an OB GYN at Sutter health in California. And we are all currently enrolled in Harvard, T.H. Chan school of public health, the master of healthcare management.

So very special, a masters it's focused on physicians. It's a two two-year program designed to support physician leaders and physician. We are currently taking a marketing class, taught by Linda McCracken. Who's very well known across the country for her marketing expertise. And our project is to define a clinical problem and a marketing strategy.

I'm using focused marketing techniques to address the clinical problem. And we have really chosen to focus on fertility and with Colleen. Expertise in billing Montana with her fertility expertise, we're going to focus in that area. So that's why we're talking to you today, Griffin, and really glad for the opportunity.

[00:03:54] Griffin Jones: The pleasure is entirely mine. Why did you choose fertility? Did Colleen strong arm, the rest of you? Or how did, how did you choose that? This was the opportunity in the nexus of medicine and business that we want to explore. 

[00:04:11] Dr. Sapugay: So, you know, infertility, afflicts, not only insured patients or the wealthy, but it all, it afflicts all kinds of women in all walks of life and with expansion in billings. Our goal is to. Have health equity, even within the infertility sphere

so if we are able to reach patients with infertility issues in rural America minority women that would be something. That we would like to enter and possibly, you know, reach patients who have not been reached before in the infertility sphere.

So in your experience, what has been the best way to reach in for fertility patients?

Is it by engaging them directly? Engaging their community or going through the providers that they see, like their obstetrician gynecologist or their primary care physicians and for our target population. Would we do that differently for patients in rural America. 

[00:05:28] Griffin Jones: So the second, the answer to the second question, would you do it differently is likely yes.

Because the answer to the first question is it depends on the area. There's effectively three different reasons. Why a patient selects a fertility provider. There's more, but three reasons make up more than 60% of patients. Number one reason above all of the others for choosing an REI the first is a referral from their physician.

That's 21% of patients say that that was their number one. Factor in influencing their decision referred by another physician. The second is referred by a friend at 20% and the third is location. At 19%. I could be mixing up two and three. I don't think I am. If I am I'll, I'll correct it in the show notes, but those three are on the heels of each other.

21%, 20%, 19% physician referred by. And location. I actually, I think location is number two. So I'll clarify that in the show notes, but they are all close to being on the heels of each other. This isn't to say that only 21% of fertility patients are referred by a physician or only 20 19% are referred by a friend.

It's just to say, that's what they say is the most influential in choosing their decision. So when you're asking this question, I tried to add a little bit more light on attribution and how attribution needs to be triangulated for fertility patients. We don't have a perfect CRM customer relationship management software that integrates with EMR perfectly.

That does not exist yet. Till we have that. And even when we do, we need to triangulate attribution, one way is volumes from whatever we're promoting. The second is in digital attribution, through a CRM, through Google analytics, through any other digital platforms that you have. And then third is patient self reporting.

And when you do the third patient self reporting, that is where you asked the question. Of the main ways that you're trying to reach patients, whether it's online reviews, social media, if you are spending a lot in traditional media, you would want to know, is somebody hearing us on the radio or seeing us on TV and the answers to those questions need to be binary?

Yes or no. There should not be more than eight of them. There should not be less than four. Then the exact number depends on exactly how heavily you're marketing in different areas, but they have to be binary. Yes or no. Last question is of all of the, of these ways of these four different. Four to eight ways.

What was the most influential in choosing your practice? And that's how we get to, to those numbers. So MD referrals are still extremely important, important. They're just not the lion's share that we sometimes think we are. And so I'll take a breather to let you ask any followup questions before we talk about what that means for Montana.

[00:08:49] Dr. Milroy: So Griffin, this is Colleen. We have been learning a lot about market segmentation, and you're saying you take the data from those sources, you collate it together and then use that to segment your market. Correct, and to different segments. 

[00:09:04] Griffin Jones: You use it to prioritize your marketing efforts. So once you have a general baseline, which I've just given, then you also want to do it for your own.

You want to do it for your own patient base. So every practice should be doing should be triangulating attribution in this way for their own practices. And because those numbers might. Different. That's a net, that's a U S average that I just gave you. And so they will be different, but if you're so much lower and if you're finding that, wow, only 30% of our patients say they were referred by an MD.

That's an area where we probably want to invest more in physician outreach. And so getting that attribution one knows where helps you to know where you're going to prioritize. And then two, it helps you to see as you're investing in those priorities, what's being returned so that you can invest more in those areas.

[00:10:07] Dr. Sapugay: So Griffin, what I'm hearing is, so we have basically two target consumers, the physicians and then the patients themselves, when it comes to the am I right? 

[00:10:20] Griffin Jones: Well, you, I, those are the two from the top, but you start to have more, as you start to have employers that have employer coverage. And so we've even started to expand.

Were you referred by, by your employer? Benefits broker did, did a progeny or a kind body or a carrot say. Well, here's who we've got on our network and, and this doctor's available. There's also apps in and lead generation and, and the friends themselves are a market in a way, but that could be a little bit tangential.

Let's just say you've got your, your, your, your top two patients physicians, and then a quickly emerging third, the employers and the employer benefit companies.

[00:11:02] Dr. Milroy: Okay, so I'll go up with the next stuff. So we have been learning and part of our project is to design something that has an improvement in the public health area. And so our question for you is clinical design solutions more important or is a growth solution more important. 

[00:11:20] Griffin Jones: Can you define each, not just for the audience, but, but perhaps for me as well, if I'm being honest, I could guess what each of those mean, but I will help.

[00:11:39] Dr. Milroy: Yeah, a clinical design solution would be something that would improve either access or patient flow or things like that that would make the patient experience a little bit better or easier on the patient. A growth solution is where you're trying to right. Compete and grow in a market. And which one right now do you think is dominating our field in terms of being a.

You know a goal for fertility practices. 

[00:12:08] Griffin Jones: This is very hard for me to answer. I feel that you're asking, which is more common place right now. 

[00:12:16] Dr. Milroy: Yeah. What's the number one issue right now?

[00:12:19] Griffin Jones: Clinical operations is the bottleneck.

And so. That's partly inhibited growth. The experience that we have as a firm, when I came into this field, it was about new patient acquisition in some time in the past couple of years. Oh, let's call it 2018, 2019 we really had to. Away from that as a firm, because very few centers want for new patients.

The bottleneck is on the clinical operational side. So as a business development firm and a creative firm where we've started to step in is in the third and fourth phase of the. Of the patient marketing journey at least the second phase and really only using the first phase to set people up, to move through the journey faster.

So not using content so much just to get someone in the door, but using content creative the way we answer the phone videos, digital. All to help people move through the journey faster and more easily. Take up less of clinician's time. Take up less of support staff time, not call support staff with. With redundant questions, not when they go see the financial counselor, they have some familiarity with what they're going to talk about, who the financial counselor is.

And so we have focused more on supporting, not, not supporting ops directly, but on the content that allows ops to operate more smoothly, as opposed to just getting new patients in the door. And so. I think that growth is inhibited by this bottleneck that we have in the field right now there's 1100 of you calling there's 1100 board certified REIs in the United States of America.

Give or take and of a population of 330 million people. And so. Things that I was hearing when I first entered the field in 2014, we would never use someone. That's not a board certified REI is one of our docs. Never. They have to be board server. We would never use a physician assistant. We'd never use a a nurse practitioner to help with retrievals, except they are now 

and what was only a few people doing that a couple years ago now, very many people are, and the answer is because that bottleneck has to be solved for, and I would love for it to be solved for, because I would love to go back into super growth mode. But, but operations absolutely precedes growth as, as the need.

[00:15:03] Dr. Sapugay: Which is interesting question. Oh, go ahead. 

[00:15:06] Dr. Milroy: No, I was just going to say out of 1100 board certified physicians, there are two in Montana that cover the entire state. So operations is going to be your bottleneck, right? There's only two of us, so that's a great, great influencer in our lives. 

[00:15:21] Griffin Jones: And I don't believe that the two are, are mutually exclusive.

I don't think that they're divorced from each other when we're having this conversation. We have to choose then yes, I'm going to say operations, but the way I've built my entire firm is to support that operation so that, so we take what was growth in terms of acquisition and turn it into. Patients that have more, that are better educated that understand the process of the clinic that have rapport with the physician so that operations can move.

I don't think that they're totally divorced from each other. And I think. Too compartmentalized is a mistake, but to your point, Colleen, about there being two of those in Montana, that's the case in a lot of states and cities across the country. And I've talked about it a lot on the podcast that it concerns me.

I don't have data, but it just seems to me, if I talk to 10 fellows a year, eight of them are going to a handful of cities, right? It seems to me that 20 of the cities in the country are getting 80% of the fellows. I don't have data to support that, so it could be wrong, but it really seems that way to me.

And I would love to get that data for people. You know, it's interesting. 

[00:16:34] Dr. Sapugay: You say that because we have alum, I'm the director of OB GYN in my department. And, and et cetera. And there's a long line of infertility specialists who are trying to present to my department of 34 clinicians. So there's a lot 

[00:16:51] Griffin Jones: And tell us again where you are

[00:16:52] Dr. Sapugay: I am in the San Francisco Bay area. 

[00:16:57] Griffin Jones: Yeah. And many of the people that have been on the show, including some of the fellows who have gone to the San Francisco Bay Area. So I do talk a lot on this show about what will become of your Buffalo new York's, where I'm from, or your Youngstown Ohio's or your billings Montana's.

And I try to make a. Plug that I think this there's actually a lot of opportunity for REIs and fertility centers in those areas, but that could be tangential to what you're looking into today. Or, or maybe it's not tell me more Colleen about what you're, what you're hoping to do, or at least exploring as a venture in these underserved areas.

[00:17:45] Dr. Milroy: I think so, one of the things that we're reading is something called blue oceans. It's a an evaluation in an article by Kim and Mauborgne and at the Harvard business review. And it talks about. You know, there are red ocean strategies that really are more in a competitive market that are driven by dog eat dog.

And then there are blue oceans and blue oceans are opportunities where companies, you know, really create long lasting, visionary, successfully evolving new markets. And so they're actually not competing necessarily. They're creating their own new pie. And so that's really what we're focusing in on is how do you create this new pie maybe?

And how do you serve a market that, you know, in a health equity, you know, access issue over the course of history has not really had an opportunity to visit us an easy way. So I'll let Anna kind of ask, cause I think, or, or Leanne had some questions about the actual products that we're thinking about.

[00:18:46] Dr. Yani: This is fascinating. And so one of the marketing questions that I have Griffin is you were referring to the advent of interdisciplinary expertise that is moving a little bit away from the physician as the sole owner of this type of. And, and really building up other expertise around our limited physician, which is our, our bottleneck as a marketer, how do you set the expectations of your population that you're marketing to?

That we do have interdisciplinary expertise and that is evolving. And, and while a physician may be at the helm of someone's care, there's a lot of steps along the patient experience that engage. Other clinicians and others with expertise that that can help them be successful 

[00:19:31] Griffin Jones: Early and often is the answer to the expectation setting question.

And because we live in a world that is content dominated and we have yet to catch up to that as a field. That we live in a world that is content dominated every hour of many professionals day is dominated by the content they consume about what they're going to purchase, what they're going to eat for dinner, the research that they're doing for their work.

And using that to reset the expectations is necessary. Can't be the first time that someone calls on the phone. So, okay. So great Griffin we, we need to use content to set expectations about how it's thinking of content in the form of a Russian nesting doll. So if you think of all of the content on a topic, as deep as your point of view can go on something.

That's the, you might say that that's the. The tiniest hole doll within the Russian nesting doll and then an infographic or a shorter blog post, or a video might be the next level. And then a infographic might be the next shell. And then the next shell might be a Tik Tok representing the entire point of view.

And so when people are thinking of what's the best form of content that we should use as long form better is short form better. They both serve purposes and they both can lead to conversion both in form of acquisition and conversion to treatment. And they're both necessary for setting expectations.

But if you think of your point of view and start with. The point of view on any given topic. And in this case, we're talking about the support staff and including other doctors besides REIs and how they contribute to the comprehensive care being delivered. That point of view would start. I recommend starting as a really long article.

Really form that point of view. And then we create video from that. Then we create shorter. Then we create literally Instagram posts and then we create Tik TOK because they're all going to be seen by different people. And sometimes by the same people in that increases frequency, but we want people to. To receive these messages in different ways.

Some of them are going to some of them, it's just going to be straightforward. Some of them are going to be funnier and cuter, and that will depend on the brand voice of the people delivering the message. But to the extent that you're varying the content in this way, you can set the expectation with people that.

Don't have to always see the REI for everything. And I might be inferring into your question too much, Anne so tell me if I am, but I hear this from REI is very often that they think they equal the standard of the. Standard of care in patients eyes. And I don't think they universally equal the standard of care in patient eyes.

The bottom line is the patient has to feel and be cared for. The REI is a part of that. How much of a part of that will depend and needs to be experimented with, but. To the extent that we're setting people's expectations ahead of time that, Hey, you're going to see this person for this. Then this is John, your ultrasound technician, and this is Mary, your phlebotomist.

And this is Dr. Patel or this is your nurse practitioner to the extent that people are familiar with these folks ahead of time, it makes it a lot easier. That the REI doesn't have to be involved in every single thing all the time. 

 [00:23:23] This topic that we’re talking about today, the REI bottleneck access to care, the convergence of growth and improvement in clinical operations, is the perfect segway to introduce our new sponsor for the show, that I am so excited to announce to you. You know who it is? It’s EngagedMD. You know why I am so excited about this? Because of the 7 years that I have been in the field almost nothing has been so lopsidedly positive as the feedback that I've heard about EngagedMD. I have been recommending them for years, at least since 2015. I hear nothing but good things from the clients that use us that we recommend to use EngagedMd and from other people in the field and you’ve heard it too if you’ve listened to this show people come on this show there have been several episodes where people just bring up EngagedMd without me even asking. That’s why I had to go get a sponsorship from them. And I am so pleased to do it because this is a great time as you’re starting to think about you’re 2022. You’re sitting down, the investments that you're making to make life better for your staff and for your patients. The pretreatment education that EngagedMD allows you to scale, so that you have more rapport with your patients, so that you have true informed consent not just sticking a handful of papers or stack of papers and having them sign it but true informed consent. So that you can tailor the patient education that they need, the standard of care that they need. Talk to them about their diagnosis, their prognosis because they are better educated, they have true informed consent. That’s the type of scale that EngagedMd provides. More than half of our clients use it, I guess I gotta to talk to the remainder that don’t because everyone loves EngagedMD. And now that you’re planning for 2022, now is the time. It’s a quick win that you can give to your team to advance your practice because this is one of the leading companies in the field. They’ve got a product road map that’s as long as my arm, and they are going to be around for a long time. And you have the opportunity now to get a couple bucks off. Go to EngagedMd.com/IRH and you get 25% off your implementation fee. That's for new customers. If you're talking to them tell them you heard them on Inside Reproductive Health. Tell them you heard them from Griffin Jones. You get a couple bucks off with 25% off your implementation fee and you'll be starting your practice on the best start that you could have moving towards scale and moving towards patients who are better educated and have true informed consent with EngagedMd. EngagedMd.com/IRH. EngagedMd.com/IRH.

[00:26:14] Dr. Sapugay: So Griffin, going back to my question. Well, first of all, thank you for that.

But going back to my question of reaching our consumer, would it, from your experience, would it be different trying to reach rural America or specifically Montana where, you know, people. ARe four or five hours away that you're trying to reach. 

[00:26:37] Griffin Jones: Probably, I can give you one thing that tends to be true for rural areas that is less true for

urban coastal areas, which is the readiness of how effective organic social media is. And I'm not talking about paid social media, running ads. I'm talking about organic social and the reach that comes from that I've known when ever we work with a small Midwest market group that. And I see they don't have much of a social media presence, but as long as I can tell, okay, these are good people.

Their patients are really happy with them that it's like taking a match to dry Tinder. And that doesn't tend to be the case in larger urban coastal areas. And my hypothesis is again, I could be wrong about this, but I think that it's because. In billings, Montana or Youngstown, Ohio, or Omaha, Nebraska, if you're 28 years old and you don't have children in many of those communities, you are not part of the social fabric.

And there's very few alternatives for you. And. The center in this case has the opportunity to stop and say, where do our community? You do have a community, you have lots of neighbors, and you actually know some of these people. We're not going to identify them, but we're going to be here. And as you start to identify yourselves, you'll, you'll start to, to perhaps talk to each other.

And now we, as the center are. At at this we, the IVF center at the center of this social community, that is a means, that's an advantage for rural centers that doesn't always exist for urban centers. And the good news for them is that it doesn't, you don't have to spend a lot of money on advertising necessarily.

You do have to spend the time to, to create the content.

Did that answer your question, Anna, what was that? Did I take that off the rails? No, 

[00:28:52] Dr. Sapugay: it, it, it answered my question. Would you focus more on the providers then that are serving these patients and, and reach them through their providers? Because. As you said, if you're 28 and you don't have kids, you're sort of out of sync with social media.

[00:29:07] Griffin Jones: If I'm in a rural area, in a small market, I'm doing organic social first, the first thing I want to do is set up the attribution. So I know that if I'm wrong about this, but if I'm just having to pick something from the bat in a, in a rural small market, not even necessarily rural, but in a small market that tends to be a place where, where family is the social fabric and.

Not a Manhattan or a San Francisco, then it's, hasn't been the case every time or has it, I'm really trying to think almost every single time. It's the case that that what's missing is, is people knowing that my friend, my former coworker, my cousin. To all one went through this, but two went and saw this specialist that they're thrilled with.

And that tends to be the lowest hanging fruit in markets like this. It doesn't mean that physician outreach strategies necessary it very well may be. It tends to be the case in those marketplace that if, if, without digging into the attribution, which I would do, if I were actually talking to a client, if I'm just guessing, that's what I would do.

[00:30:21] Dr. Milroy: Chris. And I have a question. There's been an uptick into the direct consumer kind of fertility testing. And I just wonder if that is a way to reach the customer in a rural market or in a lower socioeconomic status or lower access, lower health equity area. Could that be a way that we connect with them 

[00:30:45] Griffin Jones: first?

Well, I think anytime that you have to drive three. Plus hours to a physical location anytime. And for those of you listening, Colleen putting up or hands just up to eight hours in some of these, in the interior west, that can be the case. Yeah, these are absolutely areas that expand access that ultimately serve as lead generation for treatment and for centers.

So, you know, I've had. Afton Vechery the CEO of Modern Fertility on the podcast to talk about this concept. And some people might say, oh, that's not as good as the way we would do our testing here. And that may be the case. You can come on and debate it. I'm not a clinician. What I am saying is. It is a gateway into the next step.

And to the extent that we can take out testing from the office one, it serves as lead gen two. It improves access because people don't have to travel the distances. But third is, it goes back to tying in this theme of growth and this theme of client of clinic ops, where. It's triage for the clinics.

And in many ways, if you have a bottleneck of people a two month wait list of people trying to get in, well, wouldn't it be great if, if some of these people had more information coming into the practice and you were maybe able to refer out to some of those things that an OB GYN or even a PCP could do.

So I think triage is a part of. Of this, as well as bringing the themes of growth and clinic ops together. 

[00:32:32] Dr. Milroy: Yeah, I, I wonder often, you know, in many of these kind of rural parts of America, the small critical access hospitals, many of them don't have the ability to run some of the tests. We would like them to run.

And so that direct to a patient's home where, you know, in the privacy of their home, when they don't have to go to this small town hospital where they know every single person who they walk, you know, walk by and really have to devulge this very private and scary, you know, diagnosis that, you know, they could be doing that in a little bit of a different way and putting it in the mail.

And I think that could be a really great way to, to access and to really, you know, care for these patients in the right way.

[00:33:16] Dr. Yani: I have one last question for me is do you think the future is directly working with payers and insurers to use this sort of home assessment kit in a way for fertility, for those who have a you know, basically ICD 10 diagnosis of. 

[00:33:36] Griffin Jones: That's a great question. It might be above my pay grade.

Do you mean that the providers would, would require of the, the payers to, to, go through these at-home tests before. They sent the patient to the office. 

[00:33:55] Dr. Yani: Well, so to give you an example payers are now acting in many ways, almost as a clinical conduit and a good example is, is colorectal cancer screening.

While you can't do home colonoscopy you can test your stool for blood or specialized tests to determine if you have a higher likelihood or higher risk of cancer. And so, you know, we can imagine a future state where someone has been officially diagnosed with infertility and context, their insurance company, and they're able to actually directly administer the tests.

I can imagine a future where then they direct them towards a fertility specialist that's in their network. 

[00:34:34] Griffin Jones: I think this is part of the lead gen system that many of the tests themselves are trying to do. So you're bringing up something to me of that it's interesting of, of the employer benefit brokers being the insurance company.

Doing it and being a part of it, many of the, of these tests. And there are many of them, there's a couple leaders like the ones that we mentioned, but there's so many that are trying to get into the marketplace that are raising 10, 15. It's somewhere in the 10 to $25 million ballpark of funding. And part of this business model that they have in their minds is that they want to do exactly that well.

Okay. Well, here you go, Dr. Milroy, we have these patients for you. They're ready to go. We've screened them. And so far nobody's been terribly successful at that, partly because they've been looking at the. Provider to, to pay for that. And I don't think that that's the right model. I think anytime you can go around the providers, listen, I own a client services firm and we work with providers.

I'm telling you, it's not the best way to go. If, if you can get somebody else to pay for it, that's typically better. And so I can't speak to if for certain that I think that. Having the employer benefits and insurance companies providing for it, but it could solve the challenge that has come from the providers not, and I'm thinking of one company And they were pretty good at actually nurturing the patient and getting information.

And I don't remember to what extent they did a testing, but they actually received the money from the patient and they paid the clinic and they still couldn't make that business model work because the clinic fought them on attribution. So. I'm sorry that I don't have a, a great answer for you Anne other than here's where it hasn't worked on this side.

Maybe it could work on the insurance side and if it does attribution would have to be. Either not a part of it and because the insurance company doesn't care, they want to, they want to do triage and send less people to the expensive people first that they can. Or you know, that that attribution model makes sense for them.

[00:37:02] Dr. Yani: Yep. I think that's a great answer, Griffin and got us thinking about what is that blue ocean and how do we work out those bottlenecks and those issues to, to really expand this access for those who really, really need it.

[00:37:16] Dr. Milroy: Griffin, that's all we have for you. Do you have anything for us that you'd like to ask us? 

[00:37:22] Griffin Jones: The question that, that I have is where do you see the provider involvement evolving in the next few years with regards to advanced providers with regards to OBGYN, what do you see happening in this area? Because if the bottleneck can open.

Bring a lot more water into the bottle right now, my firm is focused on, okay. We have a limited, we have a narrow passageway. We need to make sure that the what's going through that passageway is going through as quickly as it can, but I would love to open up the passageway. What do you see happening on the, the provider side?

[00:38:11] Dr. Sapugay: So I will have Colleen the last word, but as an OB GYN in my neck of the woods we actually do a lot of the initial work up and some of us do it all the way to, you know, our regular ultrasounds to look at follicles and then do intrauterine insemination. So we do do that, but it's also a very.

Saturated market in the Bay Area. And and so for some OBGYN who don't even do the workup, we have the REIs who will do it from scratch and, and take the patient all the way through. 

[00:38:55] Griffin Jones: So I, as a marketer, that seems like the logical path to providing more access, getting more people in, but I'm not a clinician.

So I can't speak to that. Colleen play devil's advocate for a second. BV old, the old hawty REI that says only REIs can be doing this. What is the argument against having a non. Board certified, a non REI board certified OB GYN. Do the workup, do the IUI, maybe even do retrievals. If that's two arguments, you can break them into two.

But what was the argument against that? 

[00:39:38] Dr. Milroy: So historically I would say it is training within that field enough that you feel comfortable really talking about the nuances and the side effects and the risks associated with things. I would say that's old school and I actually, Griffin, argue the other way, often where we are covering such a large geographical market we have to use position assistance.

So each physician is paired with a physician assistant. The physician assistant does the simple IUI, the ultrasounds, the simple infertility patients. PCOS patients. And then when those patients go through the process and they're getting to more of the difficult stages of things or surgical stages or IVF stages, that's when they're coming in to see me.

So I think it's operations and really who you train and how you train them. I think you know, we took a whole class, the three of us this summer on operations. And one of the things that we learned in that class that was super important to patient access and flow is what's called a complete. And so the way you optimize me as an REI is really to give me the patient tied up with a little ribbon and a perfect little package.

And so it's already to go. So that means I'm not ordering the basic test. It means I'm not ordering, you know, and then having them follow up with me to talk about a semen analysis, it's that all of that data. All of my team knows needs to be there before they see me is ready to go and perfectly ready for me to evaluate.

And then I can really use my degree to say, what do we do with this? What is the data out there telling me to do for next steps? You know, where is your highest chances? What's your quickest time to pregnancy. And so you're using my brain and that way, rather than ordering tests and so complete kits I think are super important.

We identified it in our operations project as one of the keys to really opening up access to fertility centers. Similar to, 

[00:41:47] Griffin Jones: Well as a non-clinician I would love to see this. I would love to see the patients that are. Coming to the REI, the ones that are in most need of the REI, but there's a couple of things that I'd see sometimes.

And the only reason I'm seeing this, I was a D student in high school biology. So no clinical background I'm coming from just, I'm looking at referral patterns and how do we get people to move through the process more quickly? And sometimes I see people. That are coming to the stay at their OB GYN for far too long.

The OBGYNs doing time intercourse, they're doing IUIs. They're doing they might be doing some other things, but they haven't even tested the male partner for a semen analysis. And I'm like, oh right. Here's this other referral source. So. That gives me a glimpse into all right. That's probably a clinical oversight.

I'm not a doctor, but, so how do you create the framework that that is the right OBGYNs that are doing this, that they have. At least some training and maybe not an accreditation, but to get you what you need to have those patients with the bone. How does that happen, 

[00:43:00] Dr. Milroy: Anna? And I can answer this together with her being a general OB GYN in the fact that I share

What I know as much as I can. And so when I go talk to the OBGYN when they are contacting me, I am sharing not only what we're doing, but why we're doing it. And so things like timed intercourse without a semen analysis probably not that helpful. And so right. Reminding my referral patterns where we live, it's not just OBGYNs, it's family practice doctors, it's critical access hospitals, it's nurse practitioners and physician's assistants that are actually really referring to me who really not never got training in this space.

And so it's really creating outreach for education for the, for my rural providers out there who may be see this three times a year. Right. And, and don't feel comfortable in that space. And so they're just trying to do whatever they can to help the patient. But in reality, they're wasting time. And so I think, you know, having access to me, like when they call me, we always answer them and always quickly respond.

And then spending time really educating them on what. What's really helpful for these patients. Anna, do you have another thought being an OB GYN? 

[00:44:14] Dr. Sapugay: I was just going to say so basic infertility management is actually part of our training 

[00:44:20] Dr. Milroy: for you as an OB GYN. Absolutely not for my physician assistant.

Who's at a rural access 

[00:44:27] Dr. Sapugay: hospital and one of the things I cannot emphasize Colleen's point on education enough. So part of my condition, actually, whenever an REI presents to my department to try to get our referrals is to do some teaching to the entire department as part of their introduction. So educating clinicians, not just OBGYNs, but to Colleen's point, you know, primary care providers is key so that the patient's time is not wasted as they're getting worked up. 

And, you know, one of the first things I always tell my patients who are coming to see me with infertility is men make up a huge proportion of infertility problems. And so that's actually one of the first things. People should be testing for and not always just assume that it's the woman's problem. The other thing though, that comes into the equation is insurance companies actually less when the OBGYNs or the primary care clinician does the testing, I suppose to when the the REI does the testing.

And so that's another reason people come to us first. 

[00:45:41] Griffin Jones: Well, what you just described is why I don't think referring provider outreach is going away as a, as a strategy, as a business development strategy. It's not the end all be all of the single source of patient attribution, but it also ties into what's needed for triage to help qualify patients that are.

To the REI to move them through more quickly. So I've enjoyed this conversation with the three of you. It's having this clinical operations framework meet a marketing framework. They're not totally divorced from each other. It is a Venn diagram and they do overlap. So I do reach a point where I say this is as far as I can go on the train.

And and it's been nice to, to talk with the three of you of where those areas meet Dr. Yanni , Dr. Sapugay, Dr. Milroy, Leanne, Anna, Colleen, having three of you guests on, I wish you the best of luck in your MBA program. And thank you for doing that extra curricular business study to improve the quality of the standard of medicine and for coming on Inside Reproductive Health.

You’ve been listening to Inside Reproductive Health, sponsored by EngagedMD. For technology to streamline patient education and informed consent, visit EngagedMD.com/IRH for 25% off your implementation fee. That’s EngagedMd.com/IRH.

117: Improve Conversion Rates by Keeping Scholarships in your Arsenal with Pamela Hirsch

This week on Inside Reproductive Health Griffin Jones interviews Pamela Hirsch from Baby Quest Foundation. After witnessing her daughter struggle to conceive, she launched Baby Quest in  2012 and has since awarded grants totaling $2.3 million. Grants like the ones from Baby Quest are not only beneficial to the patients, but also to the clinics by increasing conversion rates from consult to treatment and getting paid quicker than from insurance claims. 

In this episode we cover the topics of: 

  • The perception of scholarship programs among doctors 

  • Where to learn more about fertility scholarships

  • How to utilize these programs in your arsenal to increase conversion rates

Links: 

Pamela Hirsch: linkedin.com/in/pamelababyquest/

Baby Quest Foundation

Website: www.babyquestfoundation.org

Facebook: https://www.facebook.com/BabyQuestFoundation

Twitter: https://twitter.com/babyquestgrants 


Transcript

[00:00:56] Griffin Jones: On today's episode, I talked to Pamela Hirsch. Pam started, Baby Quest is a scholarship for those undergoing fertility treatment. They've awarded $2.3 million so far just have had their 120th baby, born from the scholarship. I'm gonna go into the details of why this is so pivotal at the finance stage between consult and treatment inside the fertility center to have relationships with scholarship programs, like this have education about them.

Today's shout out is going to go to Dr. Lora Shahine. Dr. Shahine hit me too, Baby Quest, she was a board member for. Time still, maybe as far as I know, but at least she was, and I don't know if I've shouted out Dr. Shahine. I may have, I don't really keep track of the shout outs guys. So please let Lora know that I shouted her out on this episode.

And if I already did. two shout outs is just fine. It's good to be benevolent with your shout outs. On today's episode. It's not that Baby Quest is the only good scholarship program. And I feel like people are going to be like, why the hell didn't you mention mine? I'm sorry. ECG scholarships is another really good one.

There's there's a few more that I'm forgetting that people are probably going to remind me of in the emails, but they should, and they should be on your list as well. So finance is one of the stickiest points of moving people from. Consult to treatment and having a list of scholarships and having different places that people can apply is the final catch.

For those that aren't able to get employer coverage, aren't able to get insurance coverage. Maybe you can't get a loan maybe you can't get money from friends and family. It's important that you have all of those steps. We want to reduce. The number to as minimal as possible of people that can't afford treatment and scholarships are your last line of defense, everybody needs to have them.

And so we talk about what that's like with Pam and how they interface with clinics and pay clinics, frankly, a lot more easily than many insurance companies do. So I hope you enjoy this episode with Pam Hirsch.

 Ms. Hirsch, Pam, welcome to Inside Reproductive Health. 

[00:03:10] Pamela Hirsch: Thank you. Thank you for having me here today. 

[00:03:13] Griffin Jones: You were brought to my attention organization was brought to my attention by some people that have been on your board. And I do get a lot of requests from non-profits to come on the show and sometimes I have them on and other times I'm too busy and sometimes it's little.

Of luck of the draw. So I hope people don't hate me that have wanted to be on the show, but haven't been, but Baby, Quest I knew of, because I know some of the docs that have been on your board for a few years today, I want to talk about how you work with or how you interact with. With clinics, but let's first just start off with some of the backstory of Baby Quest.

You've awarded more than $2 million at this point. You've got, you have almost 120 babies born. 

You've got 10 pregnancies right now from Baby Quest funds. So let's just talk about how. Got there and what it is that got you there 

[00:04:12] Pamela Hirsch: and actually to correct you as of yesterday, we have 120 babies. 

[00:04:17] Griffin Jones: There we go yesterday and down what a milestone

[00:04:21] Pamela Hirsch: it is.

I started Baby Quest almost 10 years ago. It will be 10 years since we've given out the first grant. This March March, 2022 will be 10 years. And I was totally out in a different area, different workspace than fertility. I was one of the founders of a group called the Princeton Review Test Prep Company.

And I had worked in education for a long time. And. After I spoke my part of the company very soon after our younger daughter started to experience issues, trying to have a child. And she and her husband first, she had a miscarriage. Then there was Clomid and there were many IUIs. And then for IVFs, each ending and miscarriage until it was discovered that she needed to have a child via surrogacy, because she couldn't carry.

And this opened my eyes to the world of infertility and seeing the disparity of those who can afford, procedures such as IVF and surrogacy and those who can't. And the fact that many people don't have insurance coverage for this. So that's when I started Baby Quest in March of 2012, that was when we first gave out our first grant.

And that was maybe $9,000 to grants. One very small one for IUI, one larger one produced the first baby in Reno, Nevada. And since then we've grown considerably. We, as I, as you said, we've given out over $2.3 million now, and 120 babies and counting, and we do this twice a year, giving out grants. 

[00:06:08] Griffin Jones: So, how did you start to get some doctors on your board?

How did you even get a board? If I look at your, I look at your board, I recognize 5, 6, 7 names on here. And so how did that come to be? 

[00:06:24] Pamela Hirsch: Well, let's see. When I first started, I pretty much saw somebody on the street and said, oh, you want to be on my board? I have no idea what, whether it would be able to be around next year, but here's the idea.

And as we progressed, obviously we became more selective and I started going to some conferences and I met some amazing doctors. I actually knew Dr. Marc Kalan first here in Encino or Los Angeles. And then, eventually by word of mouth because of what we were doing connected with several other doctors.

I believe we have six doctors from all around the country, on our board now, and we're very fortunate to have their expertise to guide us in the medical part of evaluating applicants. 

[00:07:17] Griffin Jones: So how do you evaluate applicants? One of the things that I look at from, fertility patient journey standpoint is you first, you attract their attention and.

And educate them on the problem that they're facing, then educate them on your approach to solving the solution. Then you have to get them into the office. And there's a gap from when they contact you to when they actually come in and people can fall off there and then you get them in the office and you, you ostensibly educate them or test them depending on when follow up or the first visit comes.

But then you have a gap between that consult and treatment. And in that. So between the second and third phases, finances is hugely at play. And so anything with finance. We tried to help with the system that people use on the clinic side and the information that patients are prepared with before hand.

But you're coming in, you, you are helping with that, but 120 people out of, out of all of the people that need help. Of course you are. You're helping as many people as you can. And that's a fraction. Who needs help. So how do you make that decision? 

[00:08:30] Pamela Hirsch: Right. Well, first of all, as far as when the people consult us, we, we get applicants after they've been sitting in the business office and they know what their treatment plan is.

They need IVF they need surrogacy. They need sprayed donor sperm, donor. Genetic testing to eliminate cystic fibrosis or taste, acts, something like that. And they sit there in the financial counselors office and they learn what the price tag is. And they start to cry and realize that they don't have the money.

And that's when people start to do their research on what's out there for me, you know, my insurance won't cover this, my employer, you know, won't cover this. What kind of resources are out there? So that's generally when somebody reaches out to us and when they apply and we have two grant cycles a year we receive hundreds of applications and we.

As many applications are good. We just are obviously strapped by how many donations we get. And we can only give out the amount of money that we have. So it's a very selective process and the way applicants are selected There are several committee levels. Our board consists not just of the doctors that you mentioned that will come into play, but also of financial people of women's health advocates of surrogacy agency owners of people who have dealt with infertility in their own lives and have.

Oh, an expertise in the subject, whether it's personal or professional. So the first round of applications is looks in the application is looked at, does this include everything? Did the person submitted doctors evaluation? It's everything there. That's the first round next round. We have a fantastic committee of seven people around the country and we go through the applications one by one, and we eliminate is the person asking for more than what we think.

I can give just a myriad of, of different, different criteria. Are 

[00:10:43] Griffin Jones: you investigating their coverage as well? Like they broke down in the financial office, but wait, turns out they actually do have progeny coverage. 

[00:10:51] Pamela Hirsch: They submit their insurance information and we don't do that for everybody. But we do that when it becomes, when the group is more limited, we can't do that for hundreds.

And there's. That are just, you know, if somebody is, is asking for $50,000, we can't give that to one person. And the thing with our grant is that if somebody needs. $10,000. For instance, their procedure is 15,000 and they have 5,000 of their own. They need $10,000. If we give them a thousand and say, we're giving a grant, what does that person going to do other than save money for another five years and not be able to proceed?

So our grants cover. The major portion of what the treatment plan is, whether it be IVF service, the egg donation, sperm donation, egg freezing, embryo donation, whatever. So after the first two committees, we have a financial person who looks at the application. Does the person, does the applicant seem to be spending their money wisely?

Do they have three cars for two people? Do they How, you know, if there are, do they have enough in their savings, but they just don't want to contribute it. They'd rather have somebody else paid for it. Things like that. Then after the financial committee looks at the application, the finalists go to the medical doctors, and those are the doctors that you mentioned five or six doctors who look at the same medical piece of information for each of the finalists.

Give us their judgment on this person has a decent chance to have a viable pregnancy. 

[00:12:35] Griffin Jones: You had five or six judgements back when you do that. Yes, I will 

[00:12:40] Pamela Hirsch: say yes, very true. And it makes you realize that this is not a precise science whatsoever. You're you're, you're totally right on that. There are certain times when there is just something there that maybe we haven't caught and the doctors will say, oh no, this is just not going to work.

And if that person is consistently low. On every evaluation we realize this is not a good candidate, but it's difficult. There is no perfect solution. Every single time we've done this, we have improved it. We've made corrections. We've become more diligent and there's it's. There's no perfection. Unless we had a million dollars and then we can give money to everybody, but that that's not going to happen.

[00:13:29] Griffin Jones: But speaking of a million dollars, how have you raised the 2.3 that you've been able to distribute thus far? 

[00:13:35] Pamela Hirsch: Grovelling at first, because 

[00:13:39] Griffin Jones: To whom to anybody that you could have a cocktail party with in LA, who are the first people that you graveled to. 

[00:13:46] Pamela Hirsch: Friends who charities I had donated, or my husband and I had donated to for years and years and cocktail parties and not fun chicken dinners, that cost $500 a person that we had gone to for many years.

And I had never called in any favor so that they were first on my list and I didn't make any enemies. So that's good. And then word of mouth and then social media. It just grew you know, I been very fortunate in business and I just run, you know, even though I came from the for-profit world, I really run Baby Quest as a business.

And hopefully I'm very fiscally prudent in the choices that we've made. And we, we just, it, part of it is luck. And the other part is a lot of 

hard work.

[00:14:40] Griffin Jones: So the first was from, from friends and growing the network. When did it become fundraisers or now, do you have a systematic approach for, do you have any corporate philanthropy?

How is it. 

[00:14:55] Pamela Hirsch: Sure. Started out as individuals probably crying when an earth screaming. When I got my first check, that was over a hundred dollars. I kept on like that for awhile. Then we started with some small fundraisers, again, like hikes or what did we do? Small cocktail parties, just telling people a little luncheons, telling people about Baby Quests and it kept growing word of mouth.

And now we do have a much more structured program. We offer the giving hope grant, which is for companies, corporations. If they contribute a minimum of $12,000 on a yearly basis, they can choose. To adopt one of our recipients. And that has happened a couple to several times. We have couples who've come along who have been very fortunate with their own journey to parenthood, through IVF or surrogacy.

And they'd been, they acknowledged the fact that they have been fortunate financially, so they want to pay it back. So they come to us and they say, you know, here's a grant, here's a donation of $10,000. We want to help a particular couple. They can remain anonymous. Or they can actually communicate with the couple who they, more or less adopt.

And that has happened, you know, several times, quite a bit as well. But 

[00:16:13] Griffin Jones: Can couple's earmark as a scholarship at earmarks, not the right word, because I don't mean to say set it aside for a particular case, but rather can they, can they title their scholarships so that it's, you know, it's, it's coming from Baby Quest, but this is the.

Janet and Tim Rodriguez Scholarship.  

[00:16:36] Pamela Hirsch: Exactly. We have a company called an escrow. One of the surrogacy, one of the companies that many people use for surrogacy to put their money in an escrow account, Seed Trust, and they have adopted, if you want to call it our sponsors. Recipients two or three times we have a surrogacy agency, Abundant Beginnings, which happens to be owned by my daughter who knows the surrogacy agency owner.

They have sponsored a grant we have a celebrity from real Housewives of Atlanta, Kenya Moore, who, whose hometown is Detroit. And she great generously sponsored. Two couples from Detroit one, will be having a baby next month and her grant was the Giving Hope Grant. So definitely couples, some choose to remain anonymous.

Some definitely want to name their grant. And the companies generally, we have Brides For a Cause, which is a company in Seattle based out of Seattle. And they have been very generous with sponsoring recipient. 

[00:17:43] Griffin Jones: So as you start to grow forward, I imagine the board might change every couple a years or some seats stay on for longer.

Are there, are there fixed terms? Do you have board needs now? What's that. 

[00:17:58] Pamela Hirsch: The, the term is two-year renewable. If the person wants to. And many, fortunately many of our board members have stayed on for quite a long time. I believe there's 18 of them and we just recently added two new board members. It's always good to get a new infusion of ideas.

And since our focus has changed recently to try to do more corporate outreach. Some of our board members were not adding physicians at this time, but we're looking at board members who have some corporate ties that might be helpful. 

[00:18:37] Griffin Jones: Speaking of corporate ties, have you noticed the demographics of the.

Especially the geographics of the patient population that you're awarding scholarships to start to shift because, you know, 10 years ago you had very little corporate benefits and now it's far more common and in some marketplaces it's more common than it isn't. And so, as you know, progeny and carrot and others that are trying to enter that race kind body as they start to.

Broker benefits and now you've got Facebook and Google and Amazon and Microsoft offering those kinds of benefits. Are you starting to see different folks apply for the scholarships than you were some years ago? 

[00:19:26] Pamela Hirsch: Not really now there's always a need and no matter what companies are offering insurance, which is wonderful.

If that happens, there's still a need. And we see so many nurses applying fire, firemen, policemen social workers. Just now it I wouldn't say that really has changed that much. And again, it seems as though we do get more applicants from certain cities, whether that's word of mouth, whether if the clinic telling people, but some of the major cities, Philadelphia, Dallas, Atlanta, Los Angeles, Seattle.

They see, you know, those are cities where we get a lot of applicants. 

[00:20:19] Griffin Jones: Proportionally. Do you see far fewer from mandated states than you do mandated states? 

[00:20:25] Pamela Hirsch: Not really it well, yes. In one instance, I will say that. Yes, Massachusetts. We just gave the first grant we have ever given to Massachusetts it's same sex, male.

From the military actually using a surrogate. And we, I would say Massachusetts, per people in Massachusetts apply the least amount number and the least numbers of just about anything. Populated state. I mean, if you look at a state like Montana or Wyoming, no, we're not. We don't get very many applicants from 

[00:21:02] Griffin Jones: that.

Sure. So how do you work with clinics? You know, my interest in working with clinics is always getting the prospective patient through. Journey with the least pain possible, meaning the least, the least pain to them. They know what they're getting themselves into. They're prepared. The clinic has rapport ahead of time, the least pain possible to the staff.

They have less resistance. They're getting less questions that could be answered ahead of time and spending more of their individualized time with the patient actually individualizing their care and not doing redundant things. Causing more stress and extra work for them. And at the financial end, anything that I can do to prepare.

Patients to be ready for that discussion without giving them the wrong information ahead of time. That's kind of the hard thing family is when people want financial information. Well, you could tell somebody that the base price of an IVF cycle is $15,000. That is even though you're trying to be transparent, that's not really transparent because one, they might need just timed intercourse, and then.

Kind of scared somebody away that that just needs to see a consult, even if it's with an app in your office, even via zoom, like you've just scared somebody away from that. Or it could be somebody that needs a gestational carrier. That's going to need a multi-cycle guarantee. That's going to need donor gametes and then.

And plus the meds and then all of a sudden $15,000, this is hardly a drop in that bucket. And, and, and then you've totally bait and switch someone. And so what I try to do is get someone to think about, okay, this is where in the journey you are going to get the accurate information. This is how you are going to get it.

This is how you are going to learn how to pay for it. And so preparing them of how they're going to receive the right information, as opposed to giving them the wrong information. What you do because you really come in at that place between the second and third phase between consult before treatment.

And it's for those that have gotten stuck in the financial counselor, that is, that is one of the things in the arsenal that clinics have that I think they often forget about. And so can you talk about how you work with clinics?

[00:23:23] Pamela Hirsch: We generally get the applicants after they have a plan. And actually, because we can't do the research, let's say that somebody applies and they say, well, We don't know what we're applying for. We don't know if we need an IVF or we don't know if we need an IUI or we don't know for sure if we're going to need donor rate, you know, whatever, we don't have the manpower to go through 200 or 300 applications and help the person decide what they need.

And we're not doctors to begin with. So we really. Take that applicant when they have a plan, that person has been to the clinic. In fact, okay. For donor eggs, for example, somebody who's worded need. Donor rate or surrogacy, that person really needs to have a plan because if they submit an application to us and they say, well, we may need donor eggs

we may not. The price is going to be 15,000. If we don't need them 30,000, if we do. We don't have the manpower to call each person and say, let's talk about your plan. What your, your ovarian reserve, what does your doctor say about this? What are the champ? You know, how many IVFs if you've gone through, have you had an egg retrieval and none of the eggs have turned, you know, been able to be fertilized.

We get the person really when they have a. And the plan is concrete. This is a person who has spoken with the financial counselor has explored his or her options for insurance coverage. And basically has said, I'm going to either need to take out a big loan if I don't have the money or. I, you know, because I've been denied insurance coverage because my insurance coverage will only cover the diagnosis.

It will not go one step further. So that's when we get the person. And so we have to proceed from that step of this person needs. $9,000 to proceed because they have a little bit of cash that they can do it. We will call the doctor if we love this person, if this person proceeds through all the committees, the different levels.

And we come up to an application that is really wonderful with a personal story. And we're just so impressed with the person they've spent $12,000 already on failed procedures and here they are, and they just don't have the. To proceed. We'll call the doctor office and ask if there is any chance we've asked already in the application, but we'll call and say, you know, you've indicated that you cannot give the discount to this patient.

Is there anyone we can get $500 off or a thousand dollars off so that we can help this patient and take that $500 that you give us off. And give that to another, add that to another grant for somebody else. Anyway, that's the place where we meet the applicant. 

[00:26:39] Griffin Jones: How often does the clinic meet you there on, on a request like that?

[00:26:45] Pamela Hirsch: Less than 

[00:26:45] Griffin Jones: 50%. Less than 50? Yes. All right. Well, that's why you're on the podcast because I want that number up when we talk, I want it better be hearing everyone that's listening that better be 75% next year. I want that number going up so that you can benefit more people. But other than that, so, so hopefully you get a little bit of a discount because then you can put that back and.

Some helps more people, but even if you don't get it, is, is there anything you really need from the clinic? 

[00:27:20] Pamela Hirsch: Good communication cooperation, as far as Servicing their patient returning phone calls to their patient, just being, being the clinic that anybody would expect them to be as far as customer service, as far as us.

In fact, this just happened this week. Last Monday night we told the six people who got grants. That they had received a grant. The next day we sent them paperwork explaining exactly what their grant entailed, how much money, what medications, if any, and everything. And then the procedure is we tell the clinic, your patient got a grant.

You know, the clinic had filled out some paperwork because they have to for the medical part and we tell the clinic, your patient got a grant. There are some clinics that we have worked with before that are a pleasure. I mean, the nurses responsive, the business office is responsive. It works like clockwork.

There are other times when, the patient has received a written signed statement of this is what the procedure will cost. And all of a sudden the costs seem to change and they always change in the higher, rather than the lower we are their advocates. We will fight for them. It does not happen.

[00:28:44] Griffin Jones: So, so not a lot, like the, you don't need much from the clinic and so they are better off having you in their arsenal. Like, so every clinic should have a number of these scholarships in their arsenal and. And, and you're one that has been among the more established and proven, and it had longer tenures, but there is no reason that.

Every financial office should not have a list of these. Now, the order in which that comes in there, you talk about where that comes in, but there is a last line of defense when people are like, well, we don't want to bring in people that are, are totally unqualified. Well, you, you let people make that decision as they go through the system and you can get them some information earlier to think about things, but there is a way to get people.

Paid for, from a number of these different scholarships and the better relationship they have with you. And the more they have, the more people that are going to be able to serve. I 

[00:29:50] Pamela Hirsch: think one of the things that to me is so annoying is that, and this still happens after 10 years. I understand if this would have happened 10 years ago but,

we'll get a personal story of somebody who applied has to write a two page story. And we've seen some of the comments in the stories. Even recently, my doctor says this is a scam, my doctor said I shouldn't apply. Do you know that makes us even want to give that person a grant even more so that we can show the clinic that.

We exist. And it's interesting that within the past week, even one of the clinics mentioned to one of our recipients and very skeptical, well, how in the world are we ever going to get paid from them? And it's just amazingly easy. Let's say that somebody that we've told the person that we will pay $9,000 of their clinic fees, they come to the day when that patient needs to pay the $9,000, she's at the clinic, or she's going to go there tomorrow for her baseline or for her egg retrieval, depending on when the clinic demands payment, the clinic picks up the phone calls our office

I answer or somebody else, I give them a credit card on the phone. They charged the credit card and that's it. There is no thousand pages of paperwork. There's no bureaucracy. There is somebody else with a credit card, paying the bill for the patient. Who 

[00:31:28] Griffin Jones: did I say? 75%. When I said that should be the number of centers that give you.

Discount when you ask for it. Yeah. What that number ought to be 90% by next year. Cause guess what, Pam, they are already doing that with the insurance companies who are beating them up with the corporate benefits companies that are beating them up. And and so maybe, I mean, that could be reasons and people are slammed, especially the last year and some change fertility centers are slammed.

And so I could see well, why should we do that? It's like, well, because. Partly the, if, if the need based reason isn't good enough for you, which I hope it would be, but if it isn't because of what Pam just said, you're not fighting these claims. It's talking to Baby Quest on the phone and getting a credit card number. 

[00:32:17] Pamela Hirsch: What's interesting is we have, I could actually get it out.

It's a one, what we send the doctors or what's the doctors have to fill out when somebody applies, they print our application. The website, they fill out the 15 pages of financial information and education and profession and insurance cards and insurance information and all that. And then they have three pages they take to the doctor.

Two of those pages are medical four pages, I'm sorry, assigned HIPAA form, authorizing us to be able to see the medical information. Two pages of. Height weight BMI. How many miscarriages, how many, what's your egg count? What's your AMH levels of semen analysis? That kind of stuff. And the recommendation from the doctor, what procedure do you recommend that the patient do?

And the last page? Is a letter that says to the doctors we're going to, if this big and it's in bold, if this patient is selected by Baby Quest to receive a grant, will you match our grant? Give a certain amount, give a dis count of a certain percentage, or are you unable to give a discount. And that business manager checks that were unable to give a discount so fast.

And a lot of times they'll make up an excuse. Oh, our prices are already low. Obviously they're not low enough that this person was going to be able to afford it without a grant. So that's and we reiterate. And the last paragraph, this discount, the you're allowing the patient to have is only applicable. If this person is selected for Baby Quest, if this person is not selected by us, it's your decision.

You don't have to give them. A hundred dollars off or $500 off for a thousand. You know, it's only if they're selected, but it's really easy to put that check mark there. And these are people who have spent this has happened 15, 20, $30,000 at a clinic and have had no results. And they're asking for a discount of.

A thousand dollars, $500, you know, and it's almost a crime to me that, 

[00:34:46] Griffin Jones: yeah, in an instance like that, it would be much better, especially if they've already. I spent a lot of money without success. And the fact that you're, you're not asking for one, some allows some discretion because frankly there are some centers that are a lot more expensive than others.

And some, there are a few out there that have really done everything to be economical. We've had some of those folks on the podcast and and they almost have like a different model, but. It allows them to have the discretion and say, well, you know, even if it's pretty cheap, it's like, especially if they've already been with us a couple of times, could we knock a couple hundred bucks off?

And if we are on the more expensive side, then maybe you do, maybe you do knock some more off. And that's where you would. One thing that as I'm thinking about this, Pam is I've advised people not to really be so much in the middle on pricing, strictly from a positioning, standpoint not an access to care standpoint.

If it's an access to care standpoint, It's entirely within the heart of the physician, but I still would recommend perhaps channeling that difference to something like this. And here's what I mean by positioning that the, the low cost IVF, the affordable IVF model draws people based on that, but the middle of the road doesn't.

And so in the middle of the road on pricing, very often, you're just you're just sacrificing your own margins and you're not elevated in, in the eyes of the patient, but if you feel like, well, I, I want more people to access care. This is something else you could do if you didn't want to take the middle of the road on, on the position, but you are still feeling saintly.

And do you want more people to have access to care? You could be applying that. The wins that you're having in the margins or the safety that you have in the margins there to discounts like this? 

[00:36:45] Pamela Hirsch: Well, I won't say that it is across the board bad. I mean, our board members, our own doctors who are on the board have generously when, and we don't want to overload them.

We, we never would send more than one person. I would say a year two at the most. To the same clinic, because we're not saying, oh, you have to be our clinic. And we're going to send you a ton of, of patients because we don't want to overload somebody who is giving us a discount. Who's generous enough to be doing that.

But on the other hand, some patients, it's hard to understand that. If, if this is a really great person who really needs the, the IVF and has a great chance for success, and this person is not going to be able to proceed with treatment. Wouldn't the clinic be? Happy to give a thousand dollars off and say, oh, we get a patient versus the patient is not going to be able to afford it.

If, if they don't get a grant. Yeah. 

[00:37:51] Griffin Jones: Well, well, some of them might, what if some of them want you to slam them with a with a couple of cycles? I'm thinking most probably wouldn't with how busy they are right now. But I think in. There was one market that we did. Two groups. We, we evaluated two groups this year in the same market.

It's a very competitive. Well, top 20 market growing. And that's an area where you've got really large competitors. And especially if you feel like, well, maybe we're not converting as many people we should be. Maybe this is an angle for us, right. 

[00:38:26] Pamela Hirsch: That's right. Yeah. It's just, as I say, you know, it's very disheartening to open the application.

Find a great application. Somebody who's really put the work into the application, poured their heart into their fertility journey and to see that. That there's no cooperation. And that does not mean that we won't give them a grant and people will say, well, does it mean if, if our doctor is not willing to give us a discount, does that really disqualify us from getting a grant?

Well, obviously it means, it means we have to pay a little bit more for their procedure, but it does not disqualify. Sure. We'd love everybody to be able to get a discount from their doctor, but it's not going to happen. And we're not going to disqualify somebody because we need to give an extra $2,000 in a grant because the doctor won't won't do that.

But then again, if a clinic will give a 20% discount, which usually comes up to about 2000 on the phase that, I mean, we understand clinics, can't give a discount or cannot. Promise a discount on the anesthesia, which isn't that expensive, but they can't promise that because that's out of their control and independent, some clinics can't discount.

The facility fee. They don't have their own facility, but those clinics where they do have their own facility. And we ask if they can just count the physician and the facility fee or the physician and the lab fee, if they only. Their own lab and that if it comes up to a $2,000 discount for a patient, it's fantastic.

It really helps everybody. 

[00:40:07] Griffin Jones: Well, I hope you get a few more discounts between now and next year. Maybe, maybe someone's listening. That would be a good fit for a board member, maybe a couple donors, Pam Hirsch. Thank you so much for coming on Inside Reproductive Health.

[00:40:23] Pamela Hirsch: Thank you for having. I appreciate it.

 


116: Transition Your Sales Efforts into Marketing

In this episode, Griffin expands on his past two articles about selling to fertility centers and differentiating your company. There is a right way and a wrong way, and he almost fell into the trap of doing it the wrong way. Along with telling his story in this episode, he expounds on the 7 challenges that face sales organizations today including fewer qualified prospects, limited time and access, more gatekeepers, detached point of sale, high regulation, short sales window, and paradoxically,  long sales cycle.

Listen to the full episode to hear: 

  • 7 challenges of sales

  • How some companies overspend on brand awareness

  • Proper positioning in the market

  • The transition from a sales mindset to a marketing mindset

To learn more about our Goal and Competitive Diagnostic, visit us at FertilityBridge.com


Transcript

Griffin Jones: Hi friends, on this episode of Inside Reproductive Health. I talk about the diminishing returns of fertility business marketing, and why fertility businesses are positioned as commodities in the eyes of practice owners and the execs who buy from them in the fertility field. What I tried to make different or go into more detail in the episode than I did in the written content, and I talk more about why, I think conference parties are so dangerous, I talk more about how fertility bridge directs our own sales process. And one thing that I didn't talk about in the body of the episode, Think I wanna use for the intro here is why I've doubled down on this point of view of shifting from the sales process to the marketing process.

Because every time I skip this step and try to do the things that I should be doing in positioning in the sale, I regret it. And the most recent example was at the end of 2020, because we were off from COVID. We weren't at ASRM. We weren't an MRS and PCRS and CFAS that I was just. Impatient. And even though Fertility Bridge's revenue was still going up and profit was still going up and client numbers were still going up.

I wanted to be where I wanted to be, that where I probably would've gotten, if I just had the help of some of those other things that were going on. So I decided to go on a sales blitz at the end of 2020. That was not entirely fruitless, but overall not net beneficial and not in service. To the value position that we really aspire to have.

So where I aspire to constantly develop expertise and constantly craft the points of view and put those out there to the field so that some of you hire us at least some of the time that is where. We get our value and our, how we're viewed in the eyes of you and our prospects goes up from that. And then here I am at the end of 2020 calling people, Hey, you want to do a goal diagnostic and running a sequence where we're emailing every couple of weeks and calling every couple weeks.

And again, it wasn't entirely fruitless. Some business did come from it, but it was not in service. To our brand and why it's like why that would just for eight months, because I was impatient of where we are now eight months ago, and I knew that we would be there within six months to a year, but I was captain Ahab on a whale.

And I know for some of you, it's not just being in that position. It's, you've got higher ups to report to, you've got shareholders to report to. The principle still is the same for having a little bit more of a long-term game. And then how that speeds things up later on. So those mistakes that I feel like I made, I just never want to go back to that.

There's a time where you have to do that in your career. And that should be like at the beginning or the very beginning of your company. I get it. Some people have to make the calls. They gotta they got to get any engagements where people are treating them like a vendor and they have to work their way up to either build the portfolio or everything else that's necessary for building a really good company, but it should be aspirational for most of us to get past that.

It's certainly aspirational for me. I really believe in hope that I'm past that part. There's no financial reason. For fertility bridge to do that and where we've seen the best growth where people treat us the best, where we get the best clients from that are both the most profitable that our team enjoys working on that is the highest value to the clients is when we take our time to really build out our points of view, build that into a content system, build that into a marketing system that segues into.

Genuine sales conversations, where the parameters are set by us. That level of detail, I did not go into the article, but you should know that. That's why I, that's why we did this. And so on with the show. And I really hope you enjoy it. Let's talk about selling to fertility centers, selling when fertility doctors, fertility, practice owners, and a couple of executives are the key decision-makers. Cause that's easy. Isn't it? I put two articles together. You may have read each of these articles. So I am going to give you a little bit more nuance in the podcast form.

And then in the email write-up, I will try to include. Different or new in the podcast. Some people like reading, some people like the podcast and some people like both so that, know, if you want to listen to read a different time, sometimes there's going to be more or less information in each one, even when we cover the same topic.

So the first topic I want to talk about is the challenges that fertility centers are facing. Excuse me, the businesses that call on fertility centers are facing, and then. Why the shift in sales and marketing has relegated them to vendor status they're related, but I'm going to start with seven main challenges at least that I can identify.

Why is it so damn hard to call on fertility centers? Some of these are new and some of these have probably been for as long as the field has existed, but the first is fewer qualified prospects. That's newer limited time and access more gatekeepers long sales cycle. Short sales window, paradoxically detached point of sale, and high regulation.

These are the seven challenges that I can see. So the first when I'm talking about fewer prospects it's cause I'm talking about consolidation. Stat news says that there are twice as many private equity affiliations made from 2017 to 2019. So if we think of that means. Major customer growth for some people that have the right deals.

And then for others, that means fewer customers. I know some groups that they can't make the decisions for their own group anymore. When it comes down to buying office supplies, when it comes to buying lab equipment. Which PGT provider they use. And so for some people, that's going to mean a lot more prospects. And for some people it's going to mean a lot fewer prospects because those groups have been consolidated.

Second challenge that we're facing is limited time and access. This has always been the case, but as. The field grows and the industry side of the field grows. I'm using that word deliberately because the commercial realm of the field is growing much faster than just the clinical part. And so as that happens, We're seeing more people call on the same people in the bottleneck.

And I've had Dr. Paco Arredondo on the show. I've had Dr. Andrew Meikle on the show. They have different views on the definition of entrepreneurship. I tend to agree with Dr. Meikle we'll link, both of those episodes in the podcast, but dammit, Paco. The more I think about it, the more. I just want to argue with Paco on this.

So, and Dr. Arredondo finishes Medical Preneur. He is going to come back on the show. We're going get you some free advertising to, for medical-preneur, Dr. Arredondo. I will read the whole book first. I will go through it with a highlighter and we'll talk about the exact parts where we agree and disagree.

The point is that there's a lot of people still in the owner's seat, the visionary seat for their company that are in so many different seats in sales and marketing, finance, and operations, and the seats underneath them, that it makes it even harder to call on those folks. They have not really delegated those responsibilities.

They've delegated some of the tasks, but very often not the decision-making. And that means there are more gatekeepers. This is a challenge. Number three more gatekeepers. We often think of gatekeepers just as somebody who's a receptionist who is the gatekeeper to the actual communication, like has the executives email or calendar?

That's only one fraction of who a gatekeeper is. It's much more useful to think of gatekeepers in these terms. And I think that I came up with this definition. If I didn't, you can find it someplace on the internet. Tell me why I'm a liar. But I think that I came up with this one. A gatekeeper is anyone who cannot say yes, they can only say no.

Long sales cycle. That's our fourth challenge that we're having is that sometimes it takes months for you to be able to call on somebody in order to even get that first meeting. And then to between the first meeting, when they're actually ready to purchase, they've got construction delays. They break up with their partner, they get consolidated, the recruiting, somebody.

Sometimes they wait for the pain to hurt worse, and it usually takes a long time to get in the door, get all the stakeholders. For the first meeting for the follow-up meeting, get the, yes, get the signature, finally get the payment. And so because of that really long sales cycle, the next one might seem paradoxical, but you think of the two as ying and yang challenge.

Number four is long sales cycle challenge. Number five is a short sales window because you've got your long sale. Your long sales cycle. You've got a short sales window because it's always hurry up and wait. It's like, when's the next fish going to be around to get on the line. So it's hurry up and wait until it's hurry up.

Again, the practice might just be opening up right now. They might not need another office for a couple years. They might not need another lab. This is, might be really big equipment that they only buy for a couple years or even decades. And maybe they just got out of a network affiliation or got rid of their EMR and hope.

God willing. They'll never have to do that again. The short sales window is the ying to the long sales cycles yang. Yeah. Challenge number six, that we've got a detached point of sale. And that sucks because in most areas of commerce today, that we're used to, as consumers, we have an attach point of sale.

I can get a handyman directly to my house. Now I can get somebody to pick me up and take me to the airport. I can book all of the arrangements for my honeymoon, with the click of a button. And it's only in a segment of. Business to business sales, where we still really don't have that. You don't buy an IVF club IVF lab at the click of a button, and that makes attribution hard.

There's not a single point of sale. And that makes some marketing efforts really difficult when you want a single source attribution. And in many cases, you're just not going to get it. There's many different ways that people are choosing you. They're coming in at different points of the sales cycle and there's various decision makers. 

All of this is compounded by high regulation, and I'm not saying that's a good or a bad thing, but there are some segments of the fertility industry that the disclaimers have to be longer than the content there's limits to the interactions. They can do the joint ventures, the messaging they can do with physicians, practice owners.

And that difficulty might be obvious, but that challenge compounds how we move from. Where we are now in the sales process to where we need to be in the sales and marketing process. So I'm going to talk about that exact shift right now. So we've got these seven challenges that are really messing us up with sales.

How do we blunt some of that? And the answer has to do with moving from a lot of our efforts that are currently in sales. Towards marketing. The example that I started the other article with was who pays for dinner, because this was something that my account manager who had worked on the industry side again in air quotes of the field for a number of years, was really surprised by it.

When we go out with our clients virtually without fail, they want to pay for dinner. I like paying for dinner. I like paying for drinks to sometimes I pick up the tab, but I really like that they want to do that because it shows to me how they view the relationship. And this was not the case a couple of years ago.

And I see so frequently in our field, you're practically a vending machine. I see sometimes docs inviting their friends and it's like, oh, let's all go out to dinner on this person's bill. And sometimes it's like, it's, that's just because that's their relationship. And, but even then there still is that expectation.

And I don't like being so lopsided on that side of the value balance. So how is it that a tiny little firm like mine that had no money? Remember I came into this field in 20 14, 20 15, moved back to the United States. Virtually no money, never got any VC money, never got any, you know, like money from mommy or daddy or a commercial loan.

And also I'm not from the medical field. I don't have a clinical background. So how is it that we've been able to totally. I wouldn't say totally. I would say largely been able to move the sales process to the way that we can most help people and not acquiesce to people's unreasonable terms and do it in an efficient way where I don't have to hire an entire sales team.

I don't think that everybody in this field looks to us as the golden advisors yet, but I think I've got a lot of strong cases to make that we are moving in that direction. And our billing shows it, our client engagements show it, the people that are reaching out to us show it. And that's because we have moved more of what's in the traditionally in the sales funnel to the.

Marketing part of the funnel. If you go to the Fertility Bridge website, Google fertility, businesses as commodities, you're going to see an illustration that's by Steve Patrese that I credit on the site where you can see the marketing and sales funnel, and you can see what used to be just marketing.

What used to be just sales and how that's inversed over the last decade or so it's because. Reps. And sometimes entire companies are positioned as vendors and practice owners because they're doing too much in, in the sales and too little in marketing. The result of being over invested in the awareness stage and undifferentiated in the sale is if you're not, if you're not following this concept, there's a couple, there's two different examples that I'll give you.

One is massive industry sponsored parties that happen at our conferences. That is an over-investment in brand awareness or often an over-investment in brand awareness and expensive dinner bills and overpriced field reps, often a symptom of being undifferentiated in the sale. Don't get so mad at me.

I'm not saying that these are categorical mistakes. I will go to your events by the way, as long as we're back on this year, I'm there. You'll see me. What I'm saying is that they can be a tremendous competitive advantage when they're strategically sound. But even when they're strategically sound, I still have a couple of concerns about each.

I think it's worth saying this again, because it's probably like the ninth that I've said this on the podcast conference parties need to be careful in their positioning in of themselves guys, because they are a major PR liability. If not illegal liability, we work in fricking women's health.

And sometimes at these parties, I see behavior that I I'll say like, no, man, like don't do that, but I can't speak for other people because maybe both people are engaging, but I would not let someone. Talk to my employees like that, or do stuff like that in front of my employees, especially my female employees.

And that sometimes happens at events that are hosted in the field. And all you need is for somebody to put that on Tik TOK or put that on IG Reel whatever replace Periscope and and get picked up by the Huffington post. And now that is associated with your brand, I think that's a real liability.

So if you're going to do parties, Please have some sort of positioning for the parties themselves. Like this is why we're doing the parties. This is what we don't want to happen at our events. I do think they still are a net benefit for the field because they get us together in a way that allows us to build relationships that are really collegial because we're hanging out together.

We're not just in a conference room, going over the docket from the plenary sessions. But I am concerned about what these could do to your brand. So to just be careful. Okay. And be intentional. And let me know if you need some help with regard to the reps, the best ones are worth their weight in crypto.

They are worth hundreds of thousands of dollars a year, but so many of them do nothing. To drive sales too much payroll, too much travel, too much entertainment is wasted because reps are doing the job that you would just want your well-produced content to do. So this is how you position for expertise and value.

If over investment over and under investment in certain stages is what's causing you to be positioned as commodities. The solution is. Flipping the sales and marketing funnel a little bit. So if you go again to Fertility Bridge.com, you can either find it from the articles that will link in this podcast page.

Or if you go to Fertility Bridge.com on the homepage, you'll see a profile for your persona. If you are a business to business fertility company, click on that, you'll find this funnel and you'll see how you can adjust your investment at the different at the different phases I'm telling you right now, it's a mistake to treat the funnel merely as a checklist, you probably do webinars.

You probably do have client testimonials. It might even have a brand video. If they're the same as everyone else's, if they don't fluidly set up the sale, it doesn't matter. What are you listening to right now? Are you listening to the Griff Jones show? Are you listening to Fertility Bridges Podcast? Or are you listening to Inside Reproductive Health?

Why is this little podcast from a D student who came into the field with no money who owns not a big genetics testing company, but a little seven figure client services firm have the biggest following for the business side of the field because we've differentiated. So when I'm talking about differentiated, I got to give another shout out to Dr.

Arredondo because Paco gave me this. Stat a couple of years ago that I've gone back to it's researched by Bain that shows that 80% of companies say they provide a superior experience, but only 8% of customers say. So So I think about this all the darn time, knowing that my stuff will always stink. Hopefully I'll have that attitude until I die and that I will always have the impetus to want to improve it because.

There is huge expectations, inflated expectations, by the way, from customers everywhere, including in the fertility field, in business to business. And there's also inflated egos on our end that we think that we're meeting the regular expectations, much more of these inflated ones. So this gap, 80% of people saying they provide a superior proposition, 8% of customers agreeing with that.

Equals satis allows, provides the formula satisfaction equals per perception, minus expectation. Let me try to say that again. Satisfaction equals perception minus expectations. So we've got this huge expectations we've got huge expectations to begin with. And so using like what we think is that like quality measures as a differentiator is a bad idea.

For that reason because the customer almost never perceives it that way, even when you really are, because everybody else will say the same thing. So if somebody else can say it, it's not a differentiator. Here's a little test for. Take all the marketing agencies in the entire world and ask them how many people are human communicators.

How many people are creative? How many people get results for their clients? How many people really get their clients? Almost everybody would raise their hand. But if you say, how many of you mother-lovers have served more than a dozen fertility companies. It would be me and three or four or five other people raising their hands.

And then you ask how many of you have exclusively sub-specialized in just the fertility field, nothing else. Bridging fertility, marketing and sales together. That's us. Raising our hand. That's what I mean by differentiation. So changing in this way, moving to adapt the shift in the buying behavior is critically important because there's just too many of you all.

And there's too few of the people that we're all counting on and it is a supply and demand game for doctor's attention. And I'm going on this, expanding on this element a little bit more, because I was so surprised at how many doctors and practice owners clicked on those emails and read those articles.

I thought that it was going to be a lot less red and opened email because I thought, well, you know, only part of our list is from the industry side, the docs, the practice owners will be less into it. I don't think so. It was one of the most popular articles that we've written in a long time and a lot of doctors were reading it.

So if doctors and practice owners are listening now and how I'm counseling people to get to your attention is doing things that make it make you want to actually spend. That fractionalized time. And that comes through content. We've put out more than a hundred podcast episodes. We've written dozens and dozens of articles.

And now I'm in a position where I don't get to dictate the sales process, but I do get to very clearly say, this is what it is. And if people really don't like that, then they just don't enter into it because I can't help people. If they don't meet a couple of criteria, I really just can't help them. And it sucks because they'll, you could still get them to buy from you, but then you're an engagement in five months and they're questioning the value or it just doesn't work.

And so I get to qualify. A lot more readily in the sales process, but there's a catch for me being able to do that. The only reason why I'm able to put so many demands on the sales process and the demands that I'm talking about putting on my sales process are I don't talk to people that aren't the principal of the firm.

If they're not the chief executive it's, if it's on the industry side or they're not. Well, the one of the owners, one of the managing partners of the practice, I just don't talk to people in this sales process. And that's not me being a jerk it's I can't really help people if there's not buy-in and alignment from the very top.

I know that I can't help people over the course. A longer period of time. So I vet that very early on. And so that's one of the things that we say in our sales process, like your principals have to be there. You've got to be on video. So the people that are in our sales. Every once in a while they'll be five or 10 minutes late, but they're not 20 minutes late.

They're not rescheduling at the last minute. They're not then expecting us to go over it's they are generally on time, which for very busy doctors is pretty darn good. And they're not calling me from the. Yeah, the 4 0 1 expressway they're calling me while they're sitting at their desk with their team and they're on video and they're face to face.

Another constraint is that our various early engagements are advisory engagements that are paid. I'll talk to somebody for 15 minutes on the phone, if they're the principal and they just need a little bit of assurance or a little bit of clarity, but that's it. It's somebody is either going to show up.

They think that it's valuable enough for them to pay for. And then we go through the process and our engagements are phased in, but the reason why I'm able to do, like, why would somebody, why would any of you pay $1,500 for advisory with us? Why would practice owners pay $600 for just a little bit of advisory with us?

It's because we've already given them that much value in content by the time they're ready for that. They're not questioning it. And so when we've put out a hundred plus podcasts episodes and several dozen blog articles and a 60 page ebook with all of these guest authors, It's to show these people in advance.

This is the way we think here's our thinking in it's unapplied form. If you want it in supplied form applied to your situation, you have to pay. But having all of this content out there allows them to decide, like, I think Griff's a loser that has no idea what he's talking about or. Wow. They have really built these systems.

They've really hired the right people. They've really reiterated this over the years with multiple different clients in multiple different markets. Yeah. I think they're probably worth at least that conversation, at least that initial engagement. And so what I'm encouraging all of you to do just by virtue of what we've done.

These last few years is to start to build this content army through the brand and through the creative messaging that connects all of the dots from marketing to sales and moves a lot of those sales efforts into marketing so that sales can truly just be what sales is, the final relationships and the closing of.

What you have established through the marketing. If you want some help with that, we do that in the goal diagnostic. If you'd like our help taking a look at your funnel, taking a look at what you're doing and just giving you a little bit of advice of how you build that machine. I hope you've enjoyed this episode and we'll do more business to business content in the future.

I promise.

115: Exploring the Role of Obesity in Fertility Medicine with Evan Richardson

Evan Richardson on Inside Reproductive Health.png

Obesity plays an important role in the worlds of many struggling with conception, and in recent years the field of Obesity Medicine has grown substantially. Weight loss makes the fertility journey so much easier while increasing the quality of life for the patient.

Today’s episode features Evan Richardson, CEO and Founder of Form Health, a modern obesity practice that remotely connects their patients to dieticians. He speaks with Griffin Jones about a wide range of topics relating to obesity and fertility, from their complicated connection all the way to the future of subspecialties and medical health as a whole.

You can find the episode anywhere you stream podcasts or at our website.

Today’s Episode Focuses On:

  • The role Of BMI in fertility

  • The importance of medical subspecialties

  • The difficulties behind sustained weight loss

  • The future of subspecialty practices

  • The relationship between obesity medicine and fertility medicine

Social Links:

Evan’s Linkedin: https://www.linkedin.com/in/evrichardson/

Form Health Website: https://www.formhealth.co

FH Facebook: https://www.facebook.com/formhealthofficial

FH Instagram: https://www.facebook.com/formhealthofficial


To learn more about our Goal and Competitive Diagnostic, visit us at FertilityBridge.com


Transcript

[00:00:00] Evan Richardson: We're a fully virtual program. So everything happens through an app. Then those patients are talking with us almost every day.

We talked to on average, we talk to our patients every day, and that's just not a sustainable model for a traditional primary care practice.

 

[00:00:55] Griffin Jones: Today on Inside Reproductive Health. I hosted Evan Richardson, who is the CEO and founder of a new tech health startup called FormHealth. Before I get into my show with Evan today, my shoutout goes to doctors, Adam Griffin, and Mike Sullivan from Buffalo IVF, who are the reasons that I got into this field more than seven years ago now, starting from a small rural village in Bolivia for $500 a month, doing organic social media to now something that is unrecognizable to that venture. And so a shout out to those guys. I don't know if they listened to the show, but you have been telling people have been getting the shout outs because you've been texting them.

So if you call on those guys or if you're friends with them. Please text them, let them know that they were in this shout out today show with Evan. I know some people are going to be grumpy with me because they want to come on the show. I've got to be real protective of who I have on the show, because this is the media platform for REI and business people in the field and practice owners.

So I've got to be really careful most of the time, I don't let industry, side folks on, although sponsorship is a different option available, but I thought it was important to talk about the ways that tech can help us. If not triaged patients, at least help you treat the patients that you need to be treating, doing the things that you need and want to be doing.

And then letting more efficient solutions help with that, which you don't. So if I sound incredulous in this interview with Evan, just because I was trying to be a good steward of how you might be combing through their value proposition. I'm not a clinician. I did my best. So you can take a listen to this show with Evan.

He's been in the tech space for a while. The health tech space for awhile. He was an early employee at Castlight health. He's a member of the board of directors of bicycle health. He was part of the founding management team at grand rounds, which is also a telemedical concierge. And so he is now in this VC startup world very much.

And I hope you enjoy the show.

 Mr. Richardson, Evan. Welcome to Inside Reproductive Health. 

[00:03:25] Evan Richardson: Very happy to be here. Thanks for thanks for making time here. 

[00:03:28] Griffin Jones: I've got to tell you that I'm a little bit not looking forward to when this episode comes out for a reason that we've gotten, I've gotten very protective of the audience of this show in the last couple years, because now we're sort of the only media outlet for the business side of fertility, which has a lot of people asking me like, hey, can I come on the show?

Can I pitch this, or can we talk about this topic? And now, like, I also want to get to the point where we're in sponsorship mode. Didn't think that was the realm that you were in, but I just know that people that have asked me to come on are going to be like, what the heck why'd you let that guy on you didn't let us, I do have an explanation, but I, and I want to go back into the I want to start backwards a little bit before.

We'd talk about what form health is, but if we could start. Why fertility, what is the relationship to fertility? Then I'll get my answer and then we'll work back and then forth again. 

[00:04:29] Evan Richardson: That makes, that makes a lot of sense. So I feel like that, to answer that question, I can tell a little bit about form, which is that we are a concierge telemedical weight loss services.

So we work within the realm of medical support. We are we are a medical practice. We treat patients and we work with those individuals to meet their broader healthcare goals within the context of helping them to lose weight. And it turns out that weight loss can be really important for fertility for a number of reasons for a number of practices folks have a BMI cutoff and patients would come in above that cutoff can't receive certain services because risks because risks around sedation for other folks, there's a, you know, a real demand for surrogates. Sometimes the surrogates don't meet a BMI threshold that's required.

And then for the broad population you know, risks around risks around becoming pregnant and then carrying a child to term all go up as BMI goes up from from the sort of obesity level, which is a BMI of 30. We've worked with fertility practices now for for quite awhile to help them to bring patients into the realm of being treatable from a fertility perspective, BMI down below any sort of hard ceilings, they may have to increase. The number of surrogates that they have available. And then also just to improve sort of all of the outcomes related to fertility all by helping their patients reduce their body mass index. And it turns out that, you know, the relation between the relationship between fertility.

And BMI is fairly clear, right? All risks to becoming pregnant or to carrying a child would turn to come down as a patient brings their BMI back towards the sort of clinically normal threshold below a BMI of 30. And that's really where we help. That's where we work with fertility providers to help, to improve not all of their outcomes and broaden the base of patients and surrogates they can work 

with.

[00:06:29] Griffin Jones: What other subspecialties of healthcare, if any, are you working with? 

[00:06:34] Evan Richardson: Yeah, well, so that's a really great question. The answer is is all so, you know, we work with primary care providers. , we work with folks in the orthopedic space and then, you know, kind of everybody else, I would say those are the big the big four with fertility kind of leading the way for the sub-specialties that we work with today.

But we do have referring providers that come from, you know, the broad. Medical subspecialties, because there really is no area of care that at wherein outcomes and patient outcomes are not improved by helping those individuals with a BMI over 30, to bring that BMI down below the obesity. 

[00:07:15] Griffin Jones: Well, I don't really give a crap about those other subspecialties, but what I am interested is a little bit more on how you partner with clinics, but the reason why I was okay with having you on the show is because there a tremendous bottleneck in fertility right now there's simply more patient demand than there are providers to be able to treat them.

And we need other means to help. I dunno if triaged is the right word, but to help with some of the treatment that doesn't need to be going on at a fertility specialist so that the fertility specialist can do what only the fertility specialists can do. And so talk a little bit, but I also brought John because it didn't seem like, you know, you were necessarily.

That you had like this really, oh, I don't know deep monetized partnership with fertility centers. Maybe I'm wrong. How do you partner with fertility center? Yeah. 

[00:08:12] Evan Richardson: So great question. Yeah. And I think, look, you're right. The challenge for fertility centers in a lot of cases is how to be as efficient as possible at delivering the care that they deliver to as many patients possible.

When you have somebody coming in, who doesn't meet one of your sort of basic requirements around care. That's a challenge to you know, to sort of work with that person, especially over a period of time. If they continue to not sort of be within that BMI limited require. What we do in partnering with fertility centers is we try to work as closely as possible with them in support of the patient's goal of fertility.

That means that we try to make the burden. In terms of getting patients to us as light as possible for those referring fertility clinics. And then we try to make sure that when that patient is ready to come back we make that process of coming back to the fertility center as easy as possible. So I would broadly kind of group our partnership into two kinds of patients.

The first one is patients whose BMI precludes them from one kind of treatment or another. So we'll hear frequently that, you know, a center has a BMI cutoff of 35 or 40 or so around IVF as a broad category. And the reasons for that, I have a lot to do risks from sedation and risk of airway collapse.

It's certain a higher BMI and the threshold depends a lot on the facilities that are available and just the, the policies that practitioners are put in place for those patients who have who have a BMI that precludes them from receiving care. We partner with the facility.

Take that patient understand their fertility goals, understand the fertility path forward for them understand the weight target that they need to achieve in order to receive in order to receive fertility treatment and work with that patient over the course of weeks and months, independent from the fertility practice.

And about the only thing that happens during that process is we update the fertility center on a regular basis and that. Frequency depends really on the fertility centers preference for those updates. Usually it's about once a month, we give them an update on sort of the patients that we're working with for them.

And then when that patient hits that BMI threshold, we then with the right amount of notice, cause then in many cases, you know, it takes you know, four to six weeks to get an appointment with a treating provider. We'll say to those patients who were ready, Hey, you hit your threshold or you're about to hit that threshold.

You're ready to go back. Let's get you set up with that care. We a ll work with the fertility, the referring fertility practice to make sure that person who previously was just not eligible for care and previously could not have received treatment. Now it gets back into their practice in a pretty seamless way.

And, and is able to get care. Typically we continue to work with those patients because now they're in the second category of care, which is patients who are eligible for fertility services, but who would but, and who are already sort of receiving those, but who would like to continue to lose weight.

And for those folks, typically we are treating alongside the referring provider. And again, you know, we make that pretty, pretty seamless to the referring provider. There is no change. 

[00:11:25] Griffin Jones: Referring provider in this case, being the REI? 

[00:11:28] Evan Richardson: That's correct. Right. Isn't the fertility is the fertility specialist. It's pretty seamless to their fertility specialists.

They don't have to do anything to change their path of treatment because is actively losing weight. We always are making sure that we're up to date on the path of treatment forward patient, and that we're practicing in line with those care needs. And the patient often, you know, continues to lose a meaningful amount of weight as they go through treatment.

We will stick with those patients oftentimes through pregnancy and then afterwards continue to help them to lose weight when it's appropriate to lose weight again, which of course it's not appropriate during break. 

[00:11:58] Griffin Jones: So while we're on the topic of referring providers. When we say referring providers, we typically talk about OB GYN, sometimes PCPs.

And one thing that I've heard from REIs for as long as I've been in the field is there's often a trepidation of disrupting their referral patterns. They don't want to they don't wanna, they don't want OB-GYNs to perceive that they're taking their patients who have always send them. So that they'll keep getting referrals.

Some, there's probably some threads of this concern that are valid often. I think it's probably not valid. OB-GYNs are just as busy if not busier than REIs. And so our PCPs and very often we're talking about low margin insurance patients which is why I'm interested in exploring this telehealth idea, but I can hear a couple people, a couple REI's in the back of my head saying, well, why would we refer these patients out to a platform like this and piss off the, you know, the, when we could be sending them back to their PCP? Sure. That's a 

[00:13:04] Evan Richardson: great question. Look, I think, you know, For some patients the PCP is a perfectly appropriate place to treat their obesity.

And in many cases, the PCP has already been a part of the discussion, right? So most patients that have obesity are counseled by their PCP, that they should be losing weight. They'll ask that BCP, hey, what should I do? And that BCP will have sort of, you know, taken them through their, their frontline treatment.

I think the reality is. In the vast majority of cases, those that mode of treatment doesn't work. And so just like we work with BCPS and, you know, different side of our business, we work with PCPs is the referring provider, as opposed to fertility as the referring provider. And we do that because the PCP say, all right, I understand that there is this new area of medicine called obesity medicine and that's our subspecialty. That's a specialty in which form health practices, our physicians, our obesity medicines board, they have they typically come from an endocrinology or primary care background, but they've all passed their ABOM. The American board obesity medicine boards.

And they just have a, just like, you know, , cardiologist has advanced experience within their area of specialty. Our physicians have advanced experience for these harder cases in the field of obesity. So while an REI might say, gee, why wouldn't I just send this back to the PCP?

Who by the way, sent me the patient the first place. I think the, the short answer is. Oftentimes those PCPs have already done the work that they're able to do and haven't gotten effective results. And in many cases, when it comes to actively treating these patients for for obesity many PCPs don't feel that they're sort of the right set of folks to deliver that care, which is why we work them as referrals as well.

[00:14:44] Griffin Jones: What evidence supports your idea that the treatment is very often unsuccessful. Obesity treatment is very often unsuccessful with the primary care. 

[00:14:54] Evan Richardson: Well, so, I think the biggest piece of evidence would simply be the continued upward climb of the rates of obesity in the United States.

Even though everybody's PCP who has a BMI over 30, we'll sit them down. You really need to change? 

[00:15:10] Griffin Jones: What are we talking? Numbers wise. And I know that you probably have this like memorize for VCs. So like numbers wise, what are we talking about obesity and that you're 

[00:15:20] Evan Richardson: discussing today, the obesity rate for adults in the U S as close to 45%.

And it depends on what what statistic you want to look at. There's a few, they're not suggesting. The pandemic and the folks that being home there've been some pretty substantial increases in that number, but, you know, here, as recently as 1982, the rates in the us were 10%, right?

This is a this is a health challenge that up until January of 2020, along with opioids was, you know, one of the two major problems at the US phase. And I think, you know, we haven't seen sort of any change there that is despite a lot of healthcare focus in the area and a lot of counseling from BCPS.

I think the challenges that for for many doctors you know, that there is a there's a sense of, Hey, know, what to deliver the right care for obesity medicine to deliver, you know, the right kind of accurate around weight loss. We need to have a very active set of interactions with a patient.

Perform health, for example, meets with our patients once a month with their physician twice a month with a dietician so they're seeing somebody from form health almost every week, and then we're a fully virtual program. So everything happens through an app. Then those patients are talking with us almost every day.

We talked to on average, we talk to our patients every day, and that's just not a sustainable model for a traditional primary care practice. In addition to that for some patients, and then there's an asterisk here because for patients who are maybe pregnant or working to get pregnant, many of the medications in the space, aren't always appropriate.

But for many physicians there's a world of medications that are helpful to. And they're not comfortable in prescribing those for a variety of reasons that have to do with training and history and all this stuff. And so, that's why you know, a lot of physicians today are excited to refer out to specialty focused obesity medicine.

[00:17:13] Griffin Jones: What kind of results are you seeing now? And if you're still in forecast mode, how will you be measuring the results? 

[00:17:19] Evan Richardson: Yeah, that's a great question. So, so, you know, we've seen results that are best in class for obesity clinics. You know, we have our specialty, as I mentioned is obesity medicine.

And so there's a fair amount of research that looks at. The rate at which folks are able to lose weight, you know, for us patients that are doing great can lose up to 25% of their body weight over the course of six months those are the results that we have seen. So very very substantial weight loss.

Typically a patient is losing about a pound a week and, you know, for some patients they'll stop and they'll say, hold on a pound a week. You know, I shouldn't, I be able to lose it faster with a medically engaged program. And the answer is. No, and you're losing weight much faster than that then it's not sustainable weight loss, and you're much more likely to stop.

And you're much more likely to see rebound after that. And so lots of studies today show that you know, about a pound a week is sort of the upper threshold for how fast somebody it's a little, it's a little faster than that when you start weight models. But the sustain rate is about a pound a week and we see that.

And I think the thing that's really important for our field is how long does somebody stay in. This kind of program. So for a lot of more traditional weight loss either self guided or guided through a program, like a weight Watchers, et cetera, people retain on those programs for a very short period of time.

Right? We're talking 20 days, right? 22, 23 days, and sort of average retention there. And if anybody's tried it themselves, you've probably had a similar experience. The first two weeks you're really motivated. Third week you started adding up. I want to keep doing this. By the end of the third, we get a couple of reasons not doing he.

Didn't what we see is that about 75% of our patients are still with us at 6, 7, 8 months. That's a lot. Right. And when somebody sticks around with you for that time, you're really able to help them make material changes in their life, lifestyle, and health. And you're really able to see those folks go from you know, from a very high BMI down to something that's more you know, more clinically help them.

[00:19:10] Griffin Jones: Have you done any abstracts yet? 

[00:19:11] Evan Richardson: We've done a couple of posters. We did a poster at the at the obesity society here last year. And we did one at ASPM, American Society of Pediatric Surgeons here this year.

[00:19:22] Griffin Jones: Summarize a couple of those findings for us. 

[00:19:25] Evan Richardson: Yeah. I think, you know, in line with what we just talked through.

So, you know, typically patients are losing about a pound, right? and that we see that retention that is, you know, very substantial during the forecast period, I think, you know, the results that we're the most proud of you know, are actually coming out of some of our work with fertility centers where, you know, we had just this month two patients who became pregnant who had been having, you know, real challenges or.

Eligible to be getting fertility services because of their weight. And after working with form, went back to their REI and are now working on building a family. So that's the kind of thing that we get really charged up about. 

[00:20:02] Griffin Jones: That's what the audience gets charged up about too. A pound a week and a longer enrollment in the program for the intervention.

What compared to baseline, I guess, what is the average intervention yield? 

[00:20:22] Evan Richardson: The average intervention, self-guided intervention doesn't yield anything. And so I think that's a really important thing to think about. So, you know, the alternative to referring to obesity medicine provider is the tele patient, hey, you know, you should maybe join a weight watchers. You should you know, you should work on this yourself self guided interventions because they don't last long. Don't tend to show great results, you know, weight watchers and others have some good clinical studies where they will show that their population is able to lose weight.

But the live reality of somebody on Weight Watchers is very different from a lot of those studies. And the reality is most patients don't stick around on those studies for very long. And so, I would suggest to folks that are listening to think about their patient population and think about those people who they've said, Hey, you know, if you want to have better outcomes on agent lose and weight and think about sort of what percentage of those folks were actually able to achieve that weight loss in our experience and, you know, sort of more broadly looking at the broader population data, it's very unusual for someone to be able to under sort of self-guidance or under.

A purely behavioral program to lose a significant amount of weight. We're not talking about 10 pounds, you know, but lose 30 plus pounds. And keep that off that's fairly rare. 

[00:21:32] Griffin Jones: Yeah. Well that was going to ask how do you stratify that a little bit more? Because I imagine some people will say, well, these programs work excellently?

And so to say like self intervention doesn't work, it could be, right, but how do you, what are some of the parameters that, show us that's true? 

[00:21:53] Evan Richardson: Yeah. So I think, you know, one of the biggest one is just the overall gain in BMI, across population. And again, that's been, you know, that the rate of obesity has been taking up you know, very substantially over the course of the last decades was really no pause right there, there is not a year in the last in the last 20 where the obesity rate in the country in the U S has gone down and that's generally the case globally. And so, you know, I think that again, if a person is not able to stay on a plan for more than a handful of weeks, they will not be able to achieve results. You know, you can think about a weight gain, typically takes a while. So for many patients, they're, you know, gaining a, you know, a couple of pounds a year on.

And they may have a year or two when they gained a substantial amount of weight. But if you asked them kind of, what was the trajectory of your weight gain over time? Typically it's, you know, it's a couple of pounds a year and just like weight gain can take a while. You know, that weight loss often can take awhile, even when it's medically assisted, right?

The fastest that you can go is about an hour a week. And so, for a lot of patients, what they find is, you know, gosh, if you're staying on that program for 14 days or 20 days, that might be fine. If you want to lose five pounds to go to the beach or for an event or something like. But when you're talking about sustained weight loss, most patients, the vast majority of patients benefit from that intervention. 

 

[00:25:38] Griffin Jones: How does the formhealth get paid? Is there a partnership from the fertility? Is there a referring fee?

[00:25:46] Evan Richardson: It's a great question. And the answer is no. So no cost to the referring provider and, you know, we look at this partnership as working to help the we're gonna help the individuals, our mutual patient to achieve their broader health goals in the context of fertility, the number one goal at the top of the list is I want to have a baby. And that's the goal that we are working towards together, but just like the fertility, especially just like the REI is not is not paying and is not able to pay. their referring provider. Fee to the provider who refers patients to form.

And you know, we think of this in terms of, you know, what value can we provide to that provider? So that's why we are keeping them updated in an effective and pretty efficient way for their time in terms of how these patients are working. That's why we're making sure that we're treating inline with that provider sort of needs for that patient when we work with them.

And really at the end of the day, this is just about us helping these patients. Together to achieve that fertility goal. 

[00:26:42] Griffin Jones: So is it a monthly subscription from 

[00:26:46] Evan Richardson: the great question? How do we get paid for? So, so, so there's two parts to how how our economics work. We are a we are a reimbursed.

Service. So when a patient sees their physician that service is submitted to their insurance, just like any other physician interaction would be. And then and then that sort of adjudicated through their insurance coverage, et cetera any cost to the patient for labs, any costs, the patients for medication all of that sort of runs through the insurance just like it would for any other medical interaction. And then in addition to that, we have a monthly fee that's $99. And that really covers the cost of the dieticians that patient works with. So there's two parts to that team. One is the physician two is the dietician. And so those dietetic services are covered by the $99 a month fee, which is paid for by the patient.

[00:27:34] Griffin Jones: I want to talk a little bit about the insurance and telemedicine, and that will make this tangent make sense because in February, 2020, I was at a small fertility conference. Very cool. Intimate fertility conference in Colorado. And we were starting to talk about this novel virus that was developing in the east, but.

[00:27:56] Evan Richardson: I haven't heard of it. 

[00:27:57] Griffin Jones: When people didn't really know what was going to happen yet so this is like the first week of February. And at that conference separately. We were also talking about the future of telemedicine, but also kind of how it was a pain in the neck because if you practiced it, if you hadn't, let's say you're in oh, Erie, Pennsylvania, and you're seeing patients.

Just across the border in New York state that you would have to have a law in some states. I don't know if this is true for Pennsylvania, New York, but at least in some states you'd have to have a license to practice in multiple states and. 

[00:28:28] Evan Richardson: That's the case in the majority of states. 

[00:28:30] Griffin Jones: Okay. And so, and then all of a sudden a month later, a lot of these regulations were put on hold and health and human services and office of civil rights I believe is, are the two agencies that that enforce HIPAA. And so they said, you know, you can use zoom, you can use FaceTime, you can use Skype. And so how did that affect or not affect you all at that time? 

[00:28:54] Evan Richardson: Really good question. You know, we have been a purely telemedical business since we got started and so we have been working within the sort of fairly complicated telemedical regulatory regime that exists. And so for us, in some ways, you know, we were already really prepared for everybody to get pretty excited about telemedicine. We didn't change the way that we work with patients.

We already had tools that were HIPAA compliant that were in place. I think some of the benefit to some providers was that, you know, some of the interstate licensing requirements or were waived or otherwise loosened for a period of time. I think, you know, for us that didn't have a big impact either because our providers, you know, were already sort of licensed in these states where they practice, you know, for us as a growing business, our perspective was we never know how long these waivers are going to last.

And they are really important for some of the emergency or near emergency medical treatment that had to happen around around COVID. But we didn't want to build our business on some of those sands that could shift pretty quickly. And so by and large, you know, everything that we did was highly compliant with the pre waiver world of telemedicine. 

[00:30:09] Griffin Jones: Your explanation of how you get paid from patients and from insurance companies and not from centers is part of the reason why I had you on the show. People sell to centers, then they're going to be more likely in that sponsorship category. I know that some other people are still going to say to me, oh, that's me too.

Why can't I come on show? Listen, sometimes I'm in a good mood, keep trying me. And but I am really interested in the idea that we just have to be doing, we have to be getting people to other solutions that are found in tech and do you think that we need to be propagating that for the triage aspect?

One concern that I've seen is, we've seen people come in and there's been a couple of them that thought, oh yeah, they're going to be great. They're going to stick around. And then it's like what? They burnt through that money pretty quickly. I didn't know you could burn through $60 million that quickly, but apparently you can and  VC is a cutthroat world. 

[00:31:07] Evan Richardson: Great parties. 

[00:31:08] Griffin Jones: So what challenges are you on the lookout for? 

[00:31:13] Evan Richardson: Yeah, look, I think, you know, we think that not surprising the world of obesity medicine, the specialty of treating treating folks in BMI north of 30 or in some cases be north of 27 with certain comorbidities. We think that is a big growth area in healthcare broadly today only about 1% of individuals with a BMI north of 30 are receiving medical treatment for their weight.

If you look at any other major medical condition type two diabetes, high blood pressure depression. Typically treatment rates settle out for reimburse services at about two thirds. And and I think, you know, we are entering a world with AMA recognizing here about seven years ago, that obesity was a medical condition with the creation of the American board of obesity medicine in a world where treatment of obesity will be more the norm. It is the exception today. It's absolutely the exception and, and I think, that's part of why, fertility, for example, has been a big growth area for us because patients weight so directly impacts their ability to to, to conceive and to carry a child.

And so I think, you know, we are headed over the next 10 years towards a world where treatment is more than normal, where we start to see treatment rates north of 50. For individuals with a BMI of 30. And that doesn't mean that all those people go to obesity sessions, right? Primary care will start to treat this more frequently, et cetera, et cetera.

But you know, in that world, what we are really looking at over the next 10 years is an incredible period of growth. And I think, you know, for us as a result, some of the biggest areas of concern are really just, you know, how do we grow effectively? How do we support that? In a way that matches with our very high level of standards for the care that our patients receive.

And how do we continue to do that as we scale out larger and across more states. So I think, you know, the the question for folks in our space is you know, as awareness grows, as referrals grow, as practitioners start to say, well, I'd refer out. If I saw high sugars, I'd refer, you know, for treatment, for what looks like it might be, know, a case diabetes.

If I saw high blood pressure, I'd probably refer out for that for treatment as well. I'm seeing somebody coming in with a BMI of 30, that is a medical condition. Of course, I'm going to refer out for that. But then as that becomes more of a norm of thinking, you know, I think the real questions are, you know, how do we as a.

As a specialty of medicine, how do we make sure that we support that growth in a way that's going to be effective and high quality for all of our patients?

[00:33:47] Griffin Jones: So what are some of the obstacles look like? Like you as the visionary of this burgeoning company, when you are thinking that six months to a year, what are the things that you're saying, this is what we're getting over as a company in the next half a year so? 

[00:34:01] Evan Richardson: Yeah, well, look, I think you know, I think supporting demand is always a big challenge as a growing company, right? So, you know what we have seen in working with and working with fertility providers and other physicians more broadly is the impact we've been able to have not really has been positive for their patients and as a result we, you know, we'll often with a as an example with a fertility provider and they'll say, great, I'm going to refer you. The folks that come in and their BMI is over 45. I can't do anything with them unless we bring that BMI down. And within a couple of months, we're seeing everybody with a BMI. 30. And they're actively treating those patients between 30 and 45, but they've seen such great results with the patients that have a very high BMI that may start to say to everybody else along the path, Hey, let me just toss these folks over to form because they know the support is there and they know the results are going to be there.

And this is something that the patients want to achieve along with their fertility. And so I think, you know, for us, we look to growth and we look to making sure that we continue to support those patients in the best darn way that we possibly can. I think, you know, the world of COVID is an interesting challenge for us as well.

Are, as I mentioned, purely tele medical patients never come into an office. That's really comfortable for patients because now they don't have to leave their home. And even as they go back to work, they don't have to leave the office. They can sit in a conference room like I am now and have that conversation with their with their practitioner receive treatment and go on about it per day.

But I think that, you know, we're going to see what changes in people's expectations, you know, w what we've seen across our business is a lot of folks have had some pretty material unplanned weight gain during COVID. And so I think that is you know, an opportunity and a challenge, because there's more folks that need help, but at the same time there's a lot more obstacles in their way that are causing the gateway to.

So I think, you know, there's some challenges from the medical side there's some challenges.

[00:35:51] Griffin Jones: I thought of two more questions that the audience will be grumpy with me. If I let you off the hook, then I've got it right. Then I've got a selfish question for myself that is of zero value to the audience.

And then lastly you can conclude with however you want. So, but I know that some people. There is sometimes a referral paranoia in this. And again I think most of it is unwarranted most of the time because of how busy we all are, but some people may see you've had luck, at least building the beginnings of relationships with a couple of groups.

They see another group on they're like, well, yeah, Person is two miles away from me. If I refer patients to form health, they're going to refer them back to this other group. 

[00:36:35] Evan Richardson: That's interesting. So, so, you know, I think all of these are things that we work really hard to just make sure for our referring physicians, when we receive a referral from a from a physician, you know, we mark that down.

 And we are working with that physician at the very least, keeping them updated on their patient's progress. And then sometimes if that patient's actively receiving treatment, then we'll kind of get the the note from the from the referring provider to make sure that our treatment path is still in line with their path of care for that same patient.

And when it comes time to send that person. We are already queued up with that. with that the referring physician, the one that sent us the patient in the first place, and we just sort of naturally send them right back and we keep we keep pretty good records on that internally, mostly. So that weekends stay in line with that physician's path of treatment.

But this isn't something where, you know somebody sends a patient. And we said, okay, well, who do we like in, you know, in the city of Boston to that referring provider? I do think, you know, we, we do have growing relationships with a number of providers nationwide and you know, we have been excited to support our relationship with those providers.

So, you know, we have a bunch of providers and say, great, know, we, help generate some content with you. We're always happy to, you know, lend or medical experts out to a little bit of content with them. We've got, you know, mutual, a webpage that we stand up. There's the opportunity to do you know, some, some joint work in building sort of practice volume.

And we're always supportive of that you know, I think we want to do whatever we can to help differentiate our practice partners, our referring partners, and help make it clear to patients that, you know, incoming to this specific REI. It's not just, Hey, you're here for one thing and one thing only, but it's a holistic solution that can include weight loss that can include all the things that patient needs to make sure that they can have the best chance possible of fertility 

[00:38:26] Griffin Jones: Hopefully, that's the more superficial concern, the more sincere concern that they will not let me off for letting you off is what are you doing with the data and what are you going to do with the data? 

[00:38:38] Evan Richardson: Good question. What we do with the data now is make sure that we're treating our patients appropriately and effectively.

I don't think that we have any plans around you know, looking at referral patterns or selling that data to other to other, you know, sort of like larger data entities or anything like that. I think, you know, there are opportunities, the things that we are really interested in with that data is publishing and making sure that the ways in which we are working with patients and the centers that we are working with you know, are really able to show the difference between those patients that, you know, that they worked with and help bring the BMI down. Some success rates they had there versus those patients who, for whatever reason were appropriate to referral or what there asking.

So we are actively working on a couple of paths now to start to publish with some of these larger opportunity groups. And if any of your viewers out there want to be part of something like that, where we can really take a look at the impact of of weight management around fertility treatment, you know, that's something where we're looking to add additional practitioners in groups into some of that work that we're doing.

[00:39:38] Griffin Jones: Okay. I think I've poked you to the extent that most of them would I think most has been filled. This is totally just for me. My two favorite influencer docks outside of the fertility field everybody's this is outside of the fertility field. My two favorite influencer docs outside the field are Jason Fung and Peter Attia and for their research and work on longevity.

And specifically with fasting protocols. This is just me. This is just me really curious how much of your protocols involve fasting or is that in your purview at all? 

[00:40:15] Evan Richardson: So not really. And I guess the first, the first thing that I'd put next to that, I think Fung and Attia are often working with folks that have very different health challenges than those people who are dealing with obesity.

Right. You know, to the extent that I've read some of their stuff. And I think they're pretty interesting, but they're really working on folks that are, you know, kind of already, you know, pretty far down the road of hitting all of the basics of helpfulness and are trying to kind of tweak and do a little bit of biohacking and really make sure that they're squeezing the most they can out of their know, out of their lives and their physical bodies.

And I think that's pretty interesting. We certainly do work with patients on multiple different protocols that help them to control calorie intake. And so, know, there's two big pieces of our care one is working with that physician. Two is working with a dietician intermittent fasting is absolutely one of the tools that our dieticians use, not so much for, you know, some of the outcomes that Attia and Fung might be you know, really focused on, but just because there's a lot of data around IF that suggests that for some people it's really helpful with controlling caloric intake. I think we're a little bit more skeptical on data suggesting that your body is burning more calories when you're doing intermittent fasting or that you have sort of increased metabolic activity when you're on IF.

But we absolutely see that it's super effective for a lot of people and helping them to control which helps them to control calorie intake. So given that, the reason I said that it's not really part of our program, this is not a required part. What we do is we try to work pretty pretty carefully with each patient to make sure that the dietetic approach we take with them is built for them.

And for some people IF just as ineffective for other folks. You know, they want to try, they want to try a different kind of restriction and I want to try, you know, meal replacement, or we may believe that's going to be highest impact for them. And so we work within those within those protocols, but there are a number of our patients that do IF and many of them find it to be pretty, pretty impactful, but they apply it and it is applied a little bit differently than what Attia and Fung are typically doing up.

[00:42:22] Griffin Jones: Well, we got to do is get you a show so that you can have those guys on your show and then they can see if they see it the same way. But that's just for me, this audience is mostly REI is mostly execs in the fertility field, a lot of practice owners. So how would you like to conclude with, to that audience Evan?

[00:42:41] Evan Richardson: Yeah, I think, you know, first it's been fun to have the opportunity just to chat with you. I think to those folks that are listening form is a practice that is really built to support your patient's outcome. And we work today with with dozens of practices across the country to help their patients to achieve better fertility outcomes, to achieve more pregnancies and carry more pregnancies to term.

And we strive to do that in a way that has as little friction to their practices as possible. What helps them to work with more patients and deliver better outcomes. And so I think, you know, to the extent that is something that folks are are excited about, and at least in our experience, a lot of practitioners are excited about working with more patients and improving outcomes for all their patients.

We're ready. And, and we'd love to hear from you and you can track us formhealth.co 

[00:43:36] Griffin Jones: I mean, I think this is the trajectory that we need to. At the very least look a lot more into, in the field to help expand text's use of applying the rest of the health treatment that we might not do. And thank you very much for coming on Inside Reproductive Health.

Thank you.

Why Fertility Businesses are Positioned as Commodities

 The shift in buying behavior that has discounted many to vendor status

WHO PAYS FOR DINNER?

Do your fertility clients reach for the bill when your check arrives after dinner? Or is it a forgone conclusion that you’re picking up the tab?

My Account Manager told me this was one of the aspects of working for Fertility Bridge that was most unusual to her. She had previously worked on the “industry side” of the fertility field where vendors are often viewed as food and beverage procurement.

I don’t necessarily want my clients to pay for my food and drinks. Sometimes I just want to treat them because I like to. Still, I really appreciate that our clients always want to pay because it’s one subtle indicator of who they view as a vendor and who they view as an advisor. 

And that got me thinking about you. 

JUST ANOTHER FERTILITY VENDOR

How is it that a tiny firm like mine has been able to move from vendor to advisor in just a couple of years, when established or well-funded groups are being discounted as a commodity? It wasn’t capital or medical or scientific expertise, that’s for sure.

As far as I can tell, the shift from vendor to advisor is correlated with the shift from sales to marketing. Many fertility companies are viewed as commodities and vendors because they are still trying to fulfill positioning needs in the sales process that now take place in the marketing process.

Every time I skip steps and try to accomplish positioning requirements in the sales process that should have been established in the marketing stages, I regret it. Comparing the results of an outbound campaign at the end of 2020, vs the effectiveness of publishing a clear and firm point of view on every segment of our sales and delivery process, (I hope) I’ve learned my lesson for the final time. When I over-invested in the sales process, I often made our firm appear as a vendor. When I do the positioning work ahead of time, we are viewed as advisors and the sales process is easier and more genuine.

POSITION AS VENDOR OR ADVISOR~POSITION IN MARKETING OR SALES

Consider the shift in the sales and marketing funnel as illustrated by Steve Patrizi. 

fertility marketing funnel

Representatives and indeed entire fertility companies are positioned as vendors by practice owners and executives because the companies are doing too much in the sales stages and too little in the marketing stages, to position their value. They are mixing tactics and skipping steps.

The result is being overinvested in the awareness stage and undifferentiated in the sale. If you’re not following the concept, a couple of examples may be familiar enough to click.

  1. Massive industry sponsored parties at fertility conferences~overinvestment in brand awareness

  2. Expensive dinner bills and overpriced field reps~undifferentiated in sale

Neither are categorical mistakes. Large events and expensive salespeople can be a tremendous competitive advantage. Still, even when they are strategically sound, there are concerns about each. 

Conference parties need careful positioning in and of themselves because they are a major public relations (if not legal) liability. Yes, you could tone it down, but conference parties are typically a zero-sum game. They’re either a grandiose affair where everyone shows up, or they get little traffic because everyone’s at the big party.  


The best reps are worth their weight in crypto, but many of the others do nothing to drive sales. Too many payroll, travel, and entertainment expenditures are wasted because reps are doing the job that well produced content is supposed to do. Furthermore, the best reps are drawn to and enhanced by good positioning. 

HOW TO POSITION FOR EXPERTISE AND VALUE

If over and underinvestment in certain stages of the sales and marketing process cause fertility businesses to be positioned as dispensable commodities, how do they position their value or expertise so that they are not easily substituted? 

Consider the Business to Business Fertility Marketing funnel here.

It’s a mistake to treat the funnel merely as a checklist. You may do webinars, have client testimonials, and even a brand video. If they’re the same as everyone else’s and if they don’t fluidly set up the sale, it doesn’t matter. The telos of a salesperson is to sell. A salesperson that cannot sell is not a good salesperson. The telos of a marketing system is to set up the sale. If a marketing system cannot set up the sale, it doesn’t matter how much you spent or what title you gave it.

NO, I SAID DIFFERENTIATION.

What differentiates your fertility company from the others? If you said, personalized customer service, we’re off to a bad start for two reasons. First, the delta between companies’ opinion of their experience and the customer’s perception is tenfold. According to research by Bain, 80% of companies say they provide a superior experience but only 8% of customers say so. 

The cause of the delivery gap has been summarized by Dr. Francisco Arredondo and others as 

Satisfaction=Perception-Expectation.

The cause for the high expectations that drive the delivery gap is the second reason that attempting to use superior customer experience as a differentiator is a bad idea: it’s undefined so no one knows what it means.

Here’s the litmus test: If I read your differentiation statement in a room of your competitors and ask who can say the same about themselves, how many will raise their hands? If you put me in a room with all of the agency owners and marketing and business development advisors in the world, how many would say they get results for their clients? Millions.  How many would say they “really get to know you” or they have an “arsenal of resources”? Most. How many could say they have served more than a dozen fertility companies? Four or five. How many raise their hand when asked if they are exclusively devoted to bridging sales and marketing for fertility companies and have a published point of view on every segment of the fertility patient marketing journey? 

One.

REARRANGE SALES AND MARKETING, GRADUATE FROM VENDOR STATUS

Failing to adapt to the shift in buying behavior from sales to marketing has left many fertility companies undifferentiated in the sale. When one corrects too many expectations in the sales process, they’re viewed as a pain in the rear. When one corrects expectations in marketing, they position themselves for an advisory role in the sale. By not differentiating their positioning early on and throughout the marketing journey, fertility companies are frequently positioned as vendors or commodities by fertility practice owners and executives. Marketing isn’t just the promotion of your company’s position, it's the continual reinforcement. You need a clear and firm point of view about everything you do, and that point of view needs to be reinforced and distributed by content before your sales reps ever have to repeat them. Who knows, maybe your customers will even buy your next dinner.

Read about how we help B2B fertility companies differentiate themselves and increase sales here.

The Diminishing Returns of Fertility Business-to-Business Marketing

It’s just B2B fertility sales. How many challenges could there possibly be?

Oh, not many, just...

  1. Fewer qualified prospects 

  2. Limited time and access

  3. More gatekeepers

  4. Long sales cycle

  5. Short sales window

  6. Detached point of sale and

  7. High regulation

Other than that, I can’t think of a single reason why it would be harder than ever for companies to sell to fertility centers. In other articles, I'll address why lack of change has relegated many B2B fertility companies to commodity status. Here, I will attempt to define the principal challenges that fertility companies face in marketing and selling to fertility centers. I will also try to explain why these very challenges inhibit fertility organizations from investing in alternative approaches to solve them.

1. Fewer prospects

Stat News reports more than twice as many private equity affiliations were made among REI and OB-GYN groups from 2017 through 2019 than were made in the previous seven years. For some companies, this means huge customer growth. For others, in certain cases, it means half as many potential customers when networks negotiate exclusive deals with other vendors. 

2. Limited time and access

When the groups are larger, the dynamic usually changes to an enterprise sale where there are more decision-makers (though many small fertility practices have the characteristics of an enterprise sale). Even when there is still one principal decision-maker, she or he frequently needs the blessing or inclusion of many others. When committee decision-making takes over, it only takes one skeptic to derail the verdict. Most of them are gatekeepers.

Among independent fertility practices, who are often the most viable prospects, the senior partners’ responsibilities as physicians almost always take priority over their responsibilities as business owners. I agree with Dr. Paco Arredondo that physicians have the intelligence and training that can set them up to be entrepreneurs, but I agree by Dr. Andrew Meikle’s definition, that most of them are not. I won’t go into why--I wrote a four part series about why most fertility practices are not entrepreneurial ventures--but this business owner-physician tension greatly reduces the time that they have to make business decisions. When they have so little time to focus on the core responsibilities of a business, they often delegate the duties without the autonomy. Also, gatekeepers...

3. More gatekeepers

Fertility sales reps often view gatekeepers as administrative assistants or receptionists. Here is a more encompassing definition of gatekeeper that will better direct your attention to the access you need. A gatekeeper is anyone who cannot say “yes”; they can only say “no”. 


4. Long sales cycle

It can take months and sometimes years from first meeting to when the client is actually ready to purchase. They have construction delays, breakups with partners, and sometimes they wait for the pain to hurt worse. It usually takes a long time to get in the door, wrangle stakeholders for follow-up meetings, get the yes, the signature, and finally get the payment. 


5, Short sales window

It’s “hurry up and wait”... until it’s “hurry up again”. A practice is opening up now. They won’t need another office for years. They may never need another lab. They only buy this type of equipment every several years or even a couple of decades. They just got out of a network affiliation and hopefully, they’ll never have to do that again. The short sales window is the yin to the long sales cycle’s yang.

6. Detached point of sale

You don’t buy an IVF lab at the click of a button. There isn’t a single digital point of sale for many business dealings in the fertility field. Because of the long-term relationship dynamics of the enterprise sale, single-source attribution of marketing efforts is sometimes impossible.

7. High regulation

For some segments of the “fertility industry” the disclaimers have to be longer than the content. There are some limits to interactions, joint ventures, and messaging with and to physicians and practice owners.This difficulty may be obvious but the challenge compounds because it prevents many companies from making the necessary move to being a media company.

CAUSE OR EFFECT?

These seven challenges have certainly made your job more difficult. Still, it’s the (not so) strategic response to these challenges that compound the sales pain many fertility companies are feeling. The solution involves brave decisions in positioning and the activation of the position by putting forth oneself as a media company. I’m not talking about putting out a couple of webinars. Be sure to subscribe to Inside Reproductive Health and Fertility Bridge to be alerted about the coming content that describes the solution in more detail. 

Read about how we help B2B fertility companies differentiate themselves and increase sales here.

114: Fostering Better Communication Standards in the Workplace with Lisa Duran

Lisa Duran on Inside Reproductive Health.png

In this week’s episode Griffin Jones and Lisa Duran talk about the challenges that leaders face in the ever-growing infertility field as their clinics’ needs change and develop. They discuss consistency and coaching methods that can help make a professional team stronger.


Lisa Duran is a consultant who has worked with a multitude of organizations with the focus of bringing teams and customers to the forefront of care. She has worked as the Chief Experience Officer for Inception, Reconceived,  the DiJulius Group, VP of Patient Experience with Vivere Health, and was Formerly Chair of the Association for Reproductive Managers through ASRM. She is an experienced public speaker that has spoken at a range of fertility and health conferences. 



Today’s Episode Focuses On:

  • Efficient Delegation Practices

  • Consistency in Behavioral Standards

  • Navigating Through Negativity in the Workplace

  • Utilizing Different Personality Types Effectively

  • Healthy Communication Strategies


Lisa’s Social Media Links:


Linkedin Handle: 

https://www.linkedin.com/in/lisa-d-4025494b/?trk=public_profile_browsemap_profile-result-card_result-card_full-click


Transcript

Griffin Jones: [00:00:40] On today's show of Inside Reproductive Health. I've got Lisa Duran back with me and we talk about leadership and the struggles that leaders are facing in the fertility field right now -  being so insanely busy, crying out for help. We talk about some of the things that they can do and the tools that they need for support. Before I get into today's show with Lisa. I know who I'm going to give today’s shout out to. It’s to  Terry and Ed Malanda from Mandell’s Pharmacy. And the reason why is because if you ever hear, when I welcome somebody onto the show and I say, Hey, Dr. Smith, welcome Joe. And I do it in that order. It's partly because of Ed Malanda. I did it like one time and Ed commented that he liked it, that it was the right mix of formal and familiar. And so because of that positive encouragement, that became the tradition for the show. So if you think that super annoying, you've got Ed to blame from it. But today’s  shout out is for Ed and Terry at Mandell’s Pharmacy.. Today's show with Lisa is about leadership. We talk about how sometimes there's mutual mystification between partners.

You know what I'm talking about  - sometimes there's negativity. People complaining that management level and that seeps through because somebody is allowed to get away with it and talk about change, not being enacted because sometimes it's just a conversation with no follow ups. So we talk about the resources for what leaders need to impact that positive change.

 Lisa has been in this field in different corners in solid stints for a while. She was the chief experience officer at Inception. She's been a consultant for the DiJulius Group, she was the chair of the association for reproductive managers, which is how I met her so many different years ago. She's been an individual consultant, so if you want her help, she has that experience and I recommend reaching out. And so I hope you really enjoy this episode with Lisa Duran.

Ms. Duran, Lisa, welcome back to Inside Reproductive Health. 

Lisa Duran: [00:02:47] Thank you. I'm so happy to be back.

Griffin Jones: [00:02:49] By the time this airs it’s going to be like episode 114, somewhere around there. And I looked just for giggles of when you were on last, and it was episode 24.

So you were on  90 episodes. It was pretty early on into the show. The audience has grown a lot since then.  Overdue to have you back and glad you're here again.

Lisa Duran: [00:03:11] Wow. Well, thanks so much for having me. What an honor it is to be back. And after so many episodes, you clearly are doing something right and something well, so thanks Griffin. 

Griffin Jones: [00:03:19] Well, you too, because you had different tenures around the field and not just like a short little stint here, but you've done good yeasts multi-year blocks in different roles as a consultant in house for a clinic at the executive level of a larger company. And so you've gotten into so many different clinics.

You've probably seen the insides of more than I have, and you have also done it in very different business models. So I'm curious as to, if you could even come across commonalities being that some of them are so different. What are some of the biggest challenges that you're seeing leaders face in fertility centers?

Lisa Duran: [00:04:05] Yeah. That is such a good question. And such an important question that we ask right now. It's interesting because when I started consulting again, I wasn't sure if I would be consulting more on the patient experience side or more on the team member experience side and and the consistent ask is for the leadership experience really, and equipping the leaders because what's happening is that pretty consistently across the board? What an amazing time it is to be in the field of infertility? What we're seeing across the board of course is great. And people are realizing that they want to have a family. And so we're seeing, you know, great growth in the industry and that is, gosh, just such a blessing and such a great thing.

What has happened in the clinics is with great growth, comes different challenges. And you know, the clinics are trying to ramp up their staff. They're trying to hire appropriately. They're trying to onboard and train while navigating, you know, the explosion of growth that they're seeing.

And what we're finding is leaders are just asking to be equipped. Equipped to lead and to go from doing to leading and, you know, the challenges are pretty universal out there. It's navigating the growth. And while keeping, you know, your team morale up and keeping the standard of care where it needs to be.

Griffin Jones: [00:05:26] What are the differences that you're seeing between things that are involved in building the patient experience versus building the team or leadership experience. What are the differences? 

Lisa Duran: [00:05:37] Well, you know, certainly in the leadership experience, you know, you're equipping them with leadership skills and we'll talk a little bit about those probably in a little while, you know, you really are trying to influence one to influence the many, right?

And then with patient experience, you know, you’re really pouring into everybody, you know, typically at one time, and then the leaders would follow up, you know, with the standards and coaching and rewarding recognizing, and then coaching for behavioral change. So it's really teaching the skills to the leaders to do all those things.

And I've been really enjoying it. I, most of my consulting lately has really been in leadership and I'm really enjoying it. 

Griffin Jones: [00:06:21] What are the skills that they need help with? 

Lisa Duran: [00:06:24] Yeah. So pretty universally, there are three things that they are asking for. They're asking to learn how to delegate well. And again, it's going from doing to leading.

That's not an easy transition. So how do they transition that and not make their team feel like they're trying to shove work on them. Right. And we can talk about that a little bit more in a bit, but the second one is coaching for behavioral change because what's happening is they are so afraid of losing good people and losing people because it's hard enough trying to hire the right fit, you know?

So they're so afraid of losing people, what happens is that at times - it’s natural - sometimes we let behavior slide that, that, you know, the behavior that doesn't exactly meet our standards. Sometimes we let it slide or we make allowances or where we give special attention or circumstances, we allow circumstances to dictate what the decisions are and sometimes we'll give people a little bit more. And then you know, and not stick to the standard. And so what happens.

Griffin Jones: [00:07:29] What you just said, Lisa is the reason why there is a crabby office lady or crabby office, man, in so many practices across the world because of what you just said well, but he's really good with the, you know, he's really good with balancing the books. She's really good with billing and or they're the only person that knows this darn EMR as a super user. So we'll let this behavior, I see it all the darn time. And I got to tell you, even as hard as this job market is, we have had some conversations with people that we, you know, we use something called the people analyzer and it's saying like, Hey, this is where you're being rated on. This is where I'm rating you. They give their input and ultimately letting them say, okay, maybe this isn't for me. And even in a hard job market like this, it's been so worth it, even being a bit understaffed because even when you're understaffed, if everybody else feels like everybody else has their back, they're willing to put through the grime of being understaffed. But if you have somebody that even if they're good at the technical aspects of their job, then it's, they're saying, well, why the heck am I going the extra mile? If this person gets away with it, I think that's what you were pointing out.

Lisa Duran: [00:08:53] Yeah, very much. And when there's lack of consistency, on what is okay and what is not, you know, what one person can do versus another and what one person can get away with versus another, that creates resentment. And then with resent, you know, when there's resentment in a team, right, that's not exactly a positive environment.

And then we're asking those teams to deliver a great patient experience. And so that consistency and adhering to the standards and making sure that you're not giving special allowances to people because you're afraid of losing them. So that coaching for behavior change in a very positive way is very important.

And you, people will respect the leader more. And when you know what's expected of you and that's very clear it, people perform better, right? 

Griffin Jones: [00:09:39] I want to zoom into the delegating part of that, you mentioned, what trouble are they having with delegation?  

Lisa Duran: [00:09:45] Yeah. So, you know, the biggest thing with delegating is first of all, the stigma and delegating people think that delegating is pawning off my work to somebody right. And then, so that, you know, it's letting go of responsibility, it's assigning work and forgetting about it and so. 

Griffin Jones: [00:10:01] For some people, it is some people that's it. That's an earned stereotype. 

Lisa Duran: [00:10:08] Yeah. I have to tell you that. Being in the centers and being with the leaders, there is not a group of harder working individuals that truly have a heart, not only for their patients, but for their teams and their heart is to keep morale up. Their heart is to deliver a great patient experience. Their intentions are in the right place and they want to learn how to lead. And this is part of it. And they're so afraid to delegate because they don't want their teams to feel like they're giving them more work when they're already feeling a little overwhelmed and you know, so that's really the heart of it. And so it's really changing the mindset that really delegation is sharing work and it's really sharing authority, which can be very exciting to somebody. Who's possibly, you know, who has thoughts and ideas on things or who may want to move up, it's sharing that authority.

And it's also providing team development, right? What a great opportunity to pour into people and develop and raise up that, you know, that next leader. And so it's really changing the mindset and then giving them tools on how to do that. 

Griffin Jones: [00:11:15] Where are they getting caught up then? Is it that? Well, my team's already overworked and I just don't want to add more to them, is that the only place they're getting hung up?  Where else? 

Lisa Duran: [00:11:25] That there's a, yeah, that's a great question. Another place is that they're afraid to give it to them because they are fearful that if that person drops the ball, it's going to affect patient care and that's a valid concern, but done in the right way.

Yeah. With, you know, checking it as a leader checks in on the progress and making sure that before it's, you know, delivered that things are going in the right direction. It won't go there, but that's a big fear they have, you know, “I know how to do it, I can do it”. Right. You know, and I don't know that this person can do it like I can do it. You know, they all have such high expectations and standards for themselves. And that's why they're in leadership positions. 

Griffin Jones: [00:12:05] Sounds like that might be in the tool set that they need. What are the tools that they need to delegate? 

Lisa Duran: [00:12:11] Well, and I actually take them through some very simple steps that helps them to do that and it would certainly identify the things that you need to let go of and making sure that they're getting the commitment and the buy-in from the team member, but teaching them the process, sitting down with them, you know, a 10 to 15 minute conversation of teaching them the processes, if they need to learn it will be beneficial in the long run.

And so teaching them the process and then having regular check-ins is essential to making sure that again, that it's not going to affect the outcome and accountability. And then also it's an opportunity to encourage that person you're delegating with and, you know, give them encouragement and that they're really doing well and that's, and the teams need that right now. 

Griffin Jones: [00:13:02] How often is it that you see positions not having outcomes because I can't speak to the rest of the clinic, but at least in the marketing sales biz dev side, I'm so often seeing no outcome for the position. I think that's a problem. I wrote an article called should I fire my fertility center’s marketing director.

So if you're looking for outcomes, I break it down at each level of marketing. This is what this marketing role can be responsible for. In outcomes because I'm seldom seeing these are the outcomes that I'm expected to fulfill as a marker, which makes delegation a lot harder. Is that how common is that in the rest of the practice?

Lisa Duran: [00:13:43] You know, it really just depends on what they're delegating, you know, they can deligate, things from patient care to administrative tasks. And that is, and that's part of what I teach them is how to discern what to delegate and how you discern that is really knowing that team member that you're delegating to knowing their strengths.

Knowing their sweet spot, understanding are they detailed, are the big picture, right? Are they thinkers? Are they feelers? You know, really knowing them and discerning what you can and can't delegate to. So yes, if you delegate, you know, something very administrative and detailed to somebody, who's a big picture person, the outcomes aren't going to be there and it's going to backfire right and so, that happens.

Griffin Jones: [00:14:26] It happens all the time on the marketing side, where people are given responsibilities and in the practice owner's mind, they're thinking I want profits to increase by X, but the person has no authority over influencing X.

They are given a responsibility or a set of responsibilities that may or may not contribute to X. At all, but they probably do partly, but there are probably other things that are necessary to actually influence the outcome, but their responsibilities are, if not entirely divorced from. They're not entirely unified with those outcomes.

And so can you talk a little bit about the relationship between outcome and authority to affect the outcome? 

Lisa Duran: [00:15:16] Yeah, well, and again, that goes back to the responsibility of that goes back to the leader and being very clear on expectations and getting mutual, understanding on expectations and those constant check-ins.

If those check-ins aren't happening, if it's not going the direction that it should have, you will see it along the way. If you're not checking in then and, and the outcome doesn't happen, right the way you expected it to really, it's kind of a shame on you. You haven't checked in and making sure that, you know, the needle was pointing up or, you know, things were moving along the way they should have been moving.

And then you know, As you work with that person and can trust that person more, the check-ins become less and less, but that's essential and making sure that the outcomes are exactly what you are expecting and making sure that the person is very clear on the outcomes. 

Griffin Jones: [00:16:06] I think that's a huge reason for, well, just a lot of conflict between leaders is one, the outcome isn't spelled out too, even when it is the person doesn't necessarily have the ability to impact it. And you have to give somebody that seat to own that outcome. 

Lisa Duran: [00:16:26] That's right. They've got to have the authority, but you know, it's I think when I talking about delegating probably more in the centers probably it's more of those things that a leader can let go of more probably administrative things. Those things that, that really. Bog them down and stop them from being able to give them the bandwidth to lead and to develop, and rather than big outcomes of whether it be profitability or whether it be patient retention or things like that. You know, that's a whole different level of delegation and right now, these leaders are just are trying to function. They're trying to do so they're trying to be nurses and they're trying to be patient services, you know, advocates. And they're trying to, because they're still doing that as well. And they're trying to lead people and they're trying to hire and onboard and all those things, so really the delegation the tasks that we talk about are probably smaller projects that we'll just take some things off their plate that will allow them some bandwidth. 

Griffin Jones: [00:17:30] Do you find that resistance or if not resistance, just difficulty to delegate is more acute where it's an independent practice owner versus a group that is within a large network that supposedly, maybe does or does not have a lot of the corporate support?

What's the difference in the ability to delegate between those two different profiles? 

Lisa Duran: [00:17:58] Gosh, you know, that's another really great question. I, as you were saying that, I was thinking about that there really isn't a big network versus a single or practice or one practice owner,there really isn't a consistent I guess pattern, if you will or strength, if you will.

I think it really depends on the leader. You know, there are some leaders that are doers and really just have a hard time prying their hands off things, you know, whether they be in a network or in a smaller practice. And there are others that, you know, that are like, yes, come and help me and so it really just depends.

It really depends on the leader. It's not necessarily. A large network with maybe more support, more corporate support versus the smaller practices. It's really very individual. 

Griffin Jones: [00:18:42] So with those leaders, and I was thinking about what you said is that sometimes they may be smaller projects, but I think maybe sometimes they're not smaller projects.

I try to write about where I really, think someone can walk away and where a leader can not walk away. Example in marketing is that I do not believe that the principal of a company can walk away from positioning Fertility Bridges positioning is set by Griffin Jones and I can bring it down to a level that my creative director then makes the brand guide with me.

And then beyond that, I can move out of some of the some of the things, but the positioning has to be set by the principal. That's an example in marketing. How do you help people determine where the leader must be involved versus what they can delegate? 

Lisa Duran: [00:19:34] Again, it's really, it's helping them to discern what the desired outcome is and knowing the people, knowing what they can delegate, you know what they can delegate into who, you know, the teams are. So yeah, every team is so different, you know, you walk into a practice and you've got a leader that's been there 20 years that, you know, does this in her sleep. And she's got a team of people that she can delegate those bigger projects to and be very confident in the outcome.

And then you've got a leader that is a new leader. That's really, frankly, is just buried in trying to, to keep their head above water and trying to function. And so, you know, it's, again, it's very individual and just really teaching them discernment that is so big on what the one with the desired outcome is and then and then two who they can delegate to. So, but, you know.

Griffin Jones: [00:20:26] It's a vicious cycle, aren't it?

Lisa Duran: [00:20:27] Yeah, it really is.

Griffin Jones: [00:20:29] If, when your time is so consumed, it is so difficult to step away to actually do the things that the leader needs to do like, you know, when we are in between hiring for positions, guess who's back in helping out in that creative director role Griff guess who's back into the senior digital role sometimes at least for parts of the things.

And that prevents me from building out more of the things that's just part of. Building a business. It's two steps forward. One step back, you get yourself back together and you keep moving forward as a leader. But it really is a vicious cycle that I think many people, I don't know if they've attempted to escape it.

My whole career is about attempting to escape that so that I can build these systems so that other people can do them. But if you can't, if you can't step away to be a leader, then you can't. To delegate those things, which in turn fulfills the prophecy. 

Lisa Duran: [00:21:27] Right it's the prophecy. Well, and you know, typically you would say you've gotta be okay to let some things fail.

Right because that's where the learning happens and that's where the accountability comes. And that is really where, you know, again, where the growth happens. And what's challenging in infertility is those, if some of those fails are results in patient care, of dropping the ball on patient care, right, that's not okay. And that's not okay with the leader. And that's exactly what I find is that leaders are so afraid and rightfully so that tells you, you know, about their heart, know, they really want patients to be well taken care of that. They're not willing to risk a patient, not being taken care of with the standard of care that they're wanting them to, or that they need to, right? And that their practice promises.

And so that is exactly why, you know, when you start to delegate, you delegate those projects that are not necessarily going to affect directly. Patient, perhaps it's something, you know, in the process of patient care, but it's not necessarily directly you know, the fail is not affecting a patient, you know, communication or care that and so those are the things that we talk about.

But one of my favorite things to do is when I'm working with like, I do a pre-assessment. I asked him, what are the pain points? Where are the, tell me some of the tasks that really prohibit you from giving you bandwidth to lead.  And then when I go in, I'll ask them to identify someone and together. We will sit there and we will go through the conversation of delegating that task and we will do it together. And so that she, or he can watch it in action and feel good about it. And then I will follow up with them. And how did that go? What results are you seeing? Are you doing your check-ins and things like that?

And I'm telling you when they see the results of that, and when they see, you know, how much they can start to let go and when they start to see the growth of their team and how it just really made people feel valued it's powerful.

Griffin Jones: [00:23:24] So you've got an assessment that helps people to measure them.

How else can we help leaders during this time of  growth? 

Lisa Duran: [00:23:31] Yes. So, you know, the second thing that I was talking about is that coaching for behavioral change. And so, yes, so I teach them, you know, how do you coach for behavioral change? How do you turn that around in a positive way, but yet holding them accountable and keeping consistency in what you expect from everybody.

So that's and that is a skill that is good in life. Right. And especially in leadership if you expect the phone to be answered like this, if it's not answered like that, right. It needs to be a quick one minute coaching you know, a redirect and making sure that the person understands the standard.

They've got their commitment, they've got the tools they need, and that they know that, you know, people don't do what organizations expect they do. What's paid attention to. And also that one minute coaching right away, all the way. Really powerful. And so that's the second tool that I teach them.

Griffin Jones: [00:24:23] That's something that you taught me six years ago, that I still think about people pay attention to what their managers pay attention to. And absolutely true for my team. If I'm not paying attention to it at a high level, it will go away. And if I'm firmly paying attention to it, then they are definitely making sure it gets done.

But some of that sounded like procedural change. When I first, when we were exchanging notes and we were talking about behavioral change, I was thinking skeptically to what degree is that even possible to change someone's behavior. So can you talk a little bit more about behavioral change? Because I often find, maybe it's, I don't know if that what evidence supports or is it against my presupposition? That many personalities are not so malleable. 

Lisa Duran: [00:25:10] Yeah. Well, you know, I think about it, I'm a parent that, you know, my kids are older now, but I think about how different my kids' personalities were and one was very malleable and the other one, you know, really pushed on everything that I, you know, that I tried to direct her on and and you know, I had to be much more intentional with her and I had to be much more diligent on not letting anything go by if I, you know, if I expected. You know, a tasks to be done and I didn't follow through with it. It's my fault again, that it didn't get done. And so I don't believe that the people can't change their behavior.

I think that there's, you know, there are two reasons why people complain and there are two reasons why people's behavior don't change typically why it doesn't change and that's, you know, they don't want to, or they don't know how to, it's just become. Right. And so, you know, so figuring that out now that I don't want to, and digging in the heels, that's not acceptable in a business and especially in a business of care.

And so that person should not be on your team. That person should not be working in a company. Right. And but the one that just doesn't know how to, or the one that's been allowed to get away with it for so long that it's just become habit or there's no consequence to it. That's changeable. 

Griffin Jones: [00:26:28] I remember you saying your daughter was a J on the Myers-Briggs J which means, which is judger on the Myers-Briggs scale, which means which, and I know because I'm a hard J which means like, we like a plan and that's a different index than like the detail.

I don't need a detailed level of planning. But if I, you know, if I'm making plans with somebody, I'll see you next Thursday at here at seven o'clock, you don't need to send me a text reminder. I'm going there at seven o'clock. And if something changes, you better let me know so I can adjust my whole schedule. And so that's something that you mentioned that you learned about your daughter, and I think that's what you're using for behavioral change.

How much are personality tests involved in the assessment? Are you using it for this purpose?

 

Lisa Duran: [00:29:45] Very much, absolutely in everything. Absolutely. You know, that, that is such a great tool of Myers-Briggs is such a great tool for teaching communication skills. Right. And for teaching understanding, and being able to delegate based on strengths and certainly in coaching for behavioral change, because if you know, you've got a J or a P, or if, you know, where you have to be a little firmer or, you know, where you can be a little bit more lenient or a little bit more broad.

And so, yes, those every clinic I go to, we start with those, we with those perspectives.

Griffin Jones: [00:30:18] I think I talked about it in episode 24. So, but people probably haven't listened to it in a while. And  just liked the story so much that I've got to say it again, but there was a year at, oh, it was at ASRM or something and you separated the group into two and you said, all right, all my big picture folks, if you described yourself as big picture, go over here.

If you described yourself as really detail oriented, go over here and then. Picture. And it was like a picture of Christmas and all of the big picture people were asked to describe it. And we said things like it's a snowy winter's night and Christmas. And someone is finally come home to, to lie against the fireplace.

And the rest of the group was like, there are 12 candles, there are four rings on the rugs. There are three logs in the fire. And I was like, oh my gosh, they really do see the world differently than we did. Yeah. Talk about that with regard to behavioral change, to getting people to use to see, okay, this is how this  personality profile might need to receive communication.  

Talk about that with regard to behavioral change, to getting people to use to see, okay, this is how this  personality profile might need to receive communication.

Lisa Duran: [00:34:09] Well, and again, it's, you know, leadership, I love quoting Spider-Man or a leadership with great power comes great responsibility. There's a responsibility as a leader to know your people and to know their strengths and to ask them, listen, are you detailed?

Are you big picture? You know, do you, or do you make decisions based on thinking or do you make decisions based on feeling so they can adapt their coaching if they don't already know. But it plays a big part in how you coach and it plays a big part in how the person receives it, most definitely.

I recently did a different exercise as it relates to communication with Myers-Briggs and it was the best one. And I thought I'm going to do this everywhere. I go now, where where separated the judgers and separated the perceivers so that remember the judges as, you know, want to make a plan and stick to it.

And that they typically yes, they're more organized and more structured where the peas are a little bit more spontaneous and typically a little bit more on big picture, but much more spontaneous. And I had each of the groups, they had to create a poster of a party invite, but they had to create the poster in the other person's language.

So the Js had to do a poster that would appeal to the Ps. And the peace had to do a poster that appealed to the J's. And it was so great because the J's poster was like, Party starts whenever,  ends whenever, you know, food is going to be great. We're going to swim sometime, you know, and you know, and we're going to have a guest, we're going to have a guest, a celebrity guest, and then the Ps how they made the Js invitation, the Js invitation was party starts at seven ends at 12, right? And here's the schedule 7 0 5. We mingle and we have cocktails. I mean, they went all the way through the schedule and at the very end, you know, 11:30 Ubers come and pick you up. And it was just such an eye-opening experience for the way people communicate differently and how they receive communication.

And that it, you know, again and as leaders, it's our responsibility to understand that with our teams. So that's part of this coaching. 

Griffin Jones: [00:36:12] It's funny because I described myself as well.  I am a big picture person and I'm also a J because I like to know when things are, because I want to move things around, but it sounds to me like the P’s poster would be more or it'd be more interesting to me. Or,  I don't know, but I know with Myers-Briggs either you take these four different combinations and then you ultimately end up with four times four, you have six, 16 different profiles and it's pretty remarkable how. When you have yours, that it really gets you, you know, one of the things that mindset is I do like to I sometimes get discouraged if I feel like I'm pushing people, because one of the talents that I have is I'm a motivator, but also I have found in my life that it’s sometimes led me to try to get people riled up about things that they don't really give a crap about. And so, and I'd sometimes get like, emotional about that, of like, well, why don't you want to conquer this? And so really strongly that profile hit me. How do you walk people through their profile. 

Lisa Duran: [00:37:22] Well, I deal with the entire team so I always do it with the entire team, including the doctors. That's, it's so much fun and to really be able to dialogue communication styles. And I hope we get to talk about physician support in this too, because that's really key in a lot of this and what's happening throughout the industry.

But I do it in the entire group. The ideal is get the entire team together and we do the profiles together and, and I have the table share their profiles, and then we take some common profiles and we stand up and we really. Then we dialogue them and then we do some you know, some different activities based on what some of the objectives are for that day but it's powerful.

Griffin Jones: [00:37:58] That personality finding might've been the reason that I started the goal diagnostic. Cause I was like, I just want to find out. Off the bat. Do I care about this person's problem more than they do? Because if I do, I'm not moving forward. If they don't care enough about it at this tiny little level, then I am not investing a darn thing left and it's been super helpful, it allowed me to totally emotionally divorced from that and run a much more profitable and well organized business.

But so you're doing this with the teams. You wanted to talk about the lessons and support, and I think I'm gonna set you up for that subtopic with a bit of a loaded question. When you were saying with great power comes great responsibility, a saying that I have is, ”the fish rots from the head”. So I wanted to ask where you see the most, where at what points of the leadership chain you’re seeing the most help.

But my view is that if it's not coming from the top. There's no hope so can you speak to that a little bit? 

Lisa Duran: [00:39:06] Yeah. And I'd like to touch on one thing before I speak to that, because it really feeds right into it, you know the which was the third thing that people are asking for, and it's positively navigating negativity in the workplace.

And you know, what happens is when everybody's busy, everybody gets, you know, of short and negativity happens. And then the physician is frustrated because, you know, they're sending attitude and, but yet the teams are frustrated because they're being asked to do things 5 billion, different ways.

And so that, you know, it kind of goes hand in hand, but I'm going to speak to the positively negative navigating negativity first. And then I'll answer the question on the physicians, because again, it really ties in,you know, I talked about earlier how there, you know, there are two reasons why people complain.

This is from the John Gordon book, the no complaining role, it's I absolutely love it. And he talks about how, you know, people complain because they feel helpless, hopeless, like things aren't going to change or it's become habit. And so, so I absolutely love whether it be with leaders or teams. And we talk about that and I have them write down all the things that you complain about, you know, no one's going to see it.

I give them little journals, write down all, everything you complained about. And then John, in his book, he goes through three steps and how to turn a habit or a mindset. And do you know how to change that just with very simple steps. And and so, you know, first of all, teaching the team, that concept, and then teaching the leaders, how to expect that from them and how to condition them.

You know, one of my favorite quotes from the book is complaining is like vomit. You feel better afterwards, but everyone else around you feels sick right and isn't that the truth. 

Griffin Jones: [00:40:52] A hundred percent and it spreads and it's very common in office environments. It might be even more common in, healthcare office environment.

So how do, so what, how do we support the physician in a way that? 

Lisa Duran: [00:41:09] Yes. And so what I found I've actually had some really amazing meetings with some physicians where they've, you know, I've had one on ones where they've said, gosh, I don't know what I'm doing wrong, but I feel like I'm complaining or I'm yelling at them all the time because they're not doing things.

And you know, my, because I'm a pleaser my first reaction is like, oh no, Fine. But I have found myself in, in, in these years, the older I get, I guess the more season I get, I find myself a little bit more bold you I, you I tell them, I said, you know what? You are such an amazing physician because you do things the way you do them.

And you putting your personality into your spin, you know, fighting for what you feel is right. Whether it be a process or a protocol or a delivery, whatever it may be,  and I need you to understand what that does to the team, you know, can you imagine, I tell them, can you imagine starting a new job and saying, this is how you schedule an appointment and then you have four different physicians saying my patients, this is how it's done.

And you have four different ways of things and then you wonder why three months later, that person leaves and you're frustrated because now the ball's being dropped because your patients are being taken care of it's because there are, these teams are having to navigate not only how to, how to do everything and how to, how to give a great experience, how to give great care, but they're learning how to navigate different processes with each doctor.

And especially in those larger clinics, it is so challenging. I feel so bad, you know, I keep thinking, you would never hire me on patient services because you would fire me. I don't know that I could remember how everybody wants to do, how differently everybody wants to do it. So, I tell them you've got to let go of some stuff and, and, and the team of doctors need to come together and you guys need to try and create some continuity.

What are some things  that you can let go of to create some consistency, to help the teams out? That's how you can support them. 

Griffin Jones: [00:43:10] But that's a leadership issue in and of itself, iIsn't it of having, this is my way. This is our way. That's not a united kingdom. That is a different section of fiefdoms controlled by different warlords that allied together sometimes for certain resources that is not a United front.

That's where I really push people when I've had people like Dr. Eckstein on the show and I'm pushing people. And I'm saying like, how do you rule by committee and consensus? And there's some people that have good and like Dr. Washington has good thoughts on that, but I really am just skeptical of the whole thing. It's part again with like this little gold diagnostic thing that we do, what we're doing in the very beginning is can we get all of these people on the same page in the beginning? Because what I used to find, when we would get into agreements with people, we would find out three months, four months, That the other partner is a totally different idea and it would just,lik, throw a wrench in works and what the hell man.

Like if you're not successful, I'm not successful. And that affects my reputation. And so, that was an issue of leadership. It's like, okay, we have to get people in the same damn room talking about the shame. Damn.

How do you get that united front? 

Lisa Duran: [00:44:30] You know? So to be honest with you, Griffin. I I have just barely started having these conversations with physicians, but I will tell you that I'm dying to have them have me back because I, you know, I tell them, I'm like, look, you know what I will facilitate, you know, let's get the four of you in a room, let's first identify before we do that, let's get the team together and identify the top three things that are very inconsistent with all of you. And where consistency will make a huge impact. Once those are identified, then get the four of you in a room and let's look at those processes or those protocols and figure out where you can create some consistency, but having someone facilitate that again The out the objective being to make the lives easier for everyone to lessen their frustration as physicians and to, you know, for team retention.

So we're not turning our teams so much. And you know, in boosting them around and also having less things to have to be frustrated with them about, you know, let's do that together. And I've had a lot of, you know, a lot of physicians say, that's great. I'm willing to do that again. It's just, let's do it.

Right. Let's do it. Let's take that step now. It's going to be just a little, you know, I mean, that's it's a huge issue. Right? And so I'm not claiming that I, you know, that I can even begin to try to fix it, but I figured, you know, what, if we fix, you know, if we can fix three things and create some continuity there, then let's start there.

And then three months from now, let's visit another three, you know, or six months from now, let's visit another three and let's visit another three. And let's just try to make some progress because we've been talking about this for years, right? Right. 

Griffin Jones: [00:46:15] Yeah. There's a lot of mutual mystification between part.

I hear it all the time. Like, well, you know, I'm talking about selling to this group or I'm talking about hiring this person, but I don't want to tell Dr yet, because. They own X percent of the company. You might want to bring it up before the last minute. And I think of all the groups that we've worked with, there's been one where we have been like their mediator in this way, but I haven't a  hard conversations is a part of leadership, isn't it? Yes. Isn't it like the most important part of leadership, because otherwise you end up leadership is about getting all the boats to row in the same direction. If you can have hard conversations, you can't get the boat rowing in the same direction.

I have a key team member that within the last month or so we had to have an uncomfortable conversation and it was important because there was just a bud of resentment on each of our ends and we're able to nip it in the bud and come to, but if we didn't have that conversation and we had to have two of them, then just that little resentment would have grown more and more. And so  how.

Lisa Duran: [00:47:29] And that is exactly how it happens. 

Griffin Jones: [00:47:30] How do you facilitate  the, all I do is just get them in the same room and act like a dick. And they either team up against me or, or realize, oh yeah, maybe we should be doing this, but how do you do it more constructively? 

Lisa Duran: [00:47:45] Frankly, to be honest with you, a conversation is not going to do any.

I'm just being transparent with you. You know, we can, I can, you know, bring people into a room and have a conversation with them and say, Hey, you need to line up and you need to be, you know, whatever. Or I wouldn't say that, but I'd facilitate that conversation of how, you know, how are you feeling? How does this make you feel?

But really it's going to be in the action. So, and that's exactly what I'm talking about the, you if, if you've got buy-in to going, okay, let's look at the processes and then you walk away right. Then they don't have time, facilitate that, you know, that exercise and you know, the, again, the practice administrators and the leaders, they're the most hardworking, amazing people, I know, you know, they are trying so hard. And so, so it's really investing the time. It's really investing, you know, a couple hours, you know, every three or every six months. And to not just talk about it and not just get agreement, but, and maybe not even get agreement, but really just talk about it and big and not just talk about it, but figure out the solutions, take a very specific protocol or a process.

And do it right there. And then have it be, you know, when everyone walks out the door, whether you like it or not, you know, some things you’re gonna like some things you're not, and this is how we're going to do it. We've all done. This we've all worked on this together. And so, know, really it's gotta be a lot more than just conversation. 

Griffin Jones: [00:49:10] Because that's the solution to one of their two reasons for complaining, which is it's helpless, nothing's ever gonna change, or it's always but the other one has always been this way. That by changing it and reducing that negativity. And when you brought that up, it made me think that my people almost never complain about clients and it's because I almost never complain about clients. And that wasn't the case in the early days, I notice that my team would like, complain about clients a little bit.

And they were getting that from me. It's ‘cause I would make like a snide comment about something. How do they not have this together? And then I zoomed in and realized, well, it's one of two things - either I'm a know it all and I'm not appreciating what somebody else is going through in their business, or we have a saying in our company where there's no such thing as bad clients, there's only bad prospects and bad process. And I had to look at myself and be like, what is it about my process that is allowing these relationships to manifest in that way, and it wasn't easy to fix it. I really had to change how people come into the company, but once they do, like, we have a really good relationship with them and now I'm not complaining anymore, which means my team isn't complaining anymore, which is good because we should not be complaining about our clients who are working their fricking tails off.

But it was something that I had to fix at a fundamental level. So what are those to do's that you're giving people? They can take a while. 

Lisa Duran: [00:50:40] Yeah, they really can. And I'll share those to do's with you. But I want to tell you that this was a very personal journey for me as well. And I picked up that book because cOVID really got me in a funk. You know, I'm an extrovert on steroids and I love being in the clinics. And for me to be, you know, in my home office, by myself for 10 hours, I was like in the fetal position, you know, when people and I found myself chronically complaining and it just became habit. And that is not who I am.

And it was really ugly and I began to not like who I was. Right and I'm like, who is that? That's not you. And I love, you know, there's a, there's a saying that I absolutely love, and it says. Of your heart. So your mouth speaks and so, you know, I realized a lot of this was a heart issue and a head issue.

And so when I picked up the book, you know, I was like, okay, I gotta change my heart. And I got changed my head, you know? And so, you know, the hearts, one thing, the head is another. And so what are those tools? So those tools, there were three things, he gives you three things which were so great, number one is  you start with the they get two versus the half two instead of I have to do this by five, you know, I get to do this by five, right. Instead of I have to stay home in my home office, well, I get to work from home and you know what I can be in my yoga pants and a t-shirt all day, you know, replacing and changing the mindset. And so you replace half two with get to, and that's a very practical thing.

And so I did the exercise where I wrote down all the things that I typically complain about. And then I  crossed out half two and forgot two and so that became, you know, what I did. So step two was racing the butt and doing the and, you know, and not saying something great. And then saying the but right. But this really sucks so this really stinks, you know, replacing them and seeing him saying things like, you know, wow. I'm just, yeah, I've got so many projects right now. You know, and I'm, I'm going to get them done, not, but I don't know how I'm going to get these done. So, you know, again, replacing that and so changing some of the verbiage helped change my mindset, but the third one was the most  powerful. And that is the one where there are boundaries set in place that I had to get people on board with me, people that I would talk to all the time. Tsey-Haye, she's a good friend of mine from Inception. I'm gonna tell her, I'm like, you gotta help me keep these boundaries, you know?

And the boundaries, we're you know, you're not allowed to just complain any time. You're not allowed to vomit on me all day long and leaders. And that's why I tell leaders. I said, if you're walking across the floor and you're going to see a patient and you let one of your team members come up and vomit on you about something, and you're going to go see that patient unacceptable, they may not vomit on you while you're, you know, needing to go do something. So, so how do you know when can they, you know, people should be able to complain, but turning complaining into productive solutions. And so, you know, that is the key. So creating the boundaries on how they do it, and we've all heard the don't come to me with a complaint without being part of a solution, but he really breaks it down very nicely.

 And really holding people accountable for being part of the solution so one of the things I work on with leaders is how do you actively listen, validate their feelings of their complaint and saying that is, you know, those are some great points. And tell me what ideas do you have to fix this?

And what part are you going to play on this? I want to support you right. And then holding them accountable for that. I'm telling you when you make people be part of the solution, not just say it, but make them be part of the solution. You're good, they're not going to come back and complain to you very much.

Griffin Jones: [00:54:19] Yeah. My operations manager says you have something you want to do at Fertility Bridge, bust out the mirror because that's the person that's going to be doing it. But as you're talking, Lisa I'm seeing the reason of the importance. For this reason as connected to each other, meaning it's so important to not have complaints and be complaint driven only, and to be solutions focused, partly because of how sensitive the self-awareness has to be to improve as a leader. Like the things that you're talking about, I don't have to, I get to -  that’s counted all joy. That is a very difficult mindset to get in and there's just so much of a leader where you have to be brutally self-aware about everything that you've built.

It's like everything I’ve built like this still, is that good or this still needs to be improved, this particular part. And because you have to be so introspective. It can feel like salt in the wound when somebody just comes on like, well, why aren't you doing this? And we had somebody, we had a candidate, a job candidate last week that was like, well, why don't you have this type of social media post is like, oh, I don't know, because I'm busy making payroll from a company that I built from. Absolutely nothing. When I called Lisa Duran from a fricking orphanage in 2015, and I'm building all these systems and serving nineteen different clients and building a point of view for everything, because I never took a dime of that's why,

like just as you're talking, I think that they're reciprocal, the solutions orientedness has to be what makes. Wound not stinging so much when you are being introspective enough to actually pursue the change. 

Lisa Duran: [00:56:13] No you're so right about that. And it seems overwhelming to a leader, but, you know, I used the example of, you know, you've got, let's say you've got a group of team members that are gossiping or that are complaining about something.

How powerful is it? And, there's kind of a ringleader in it is when a leader takes that person aside in their office privately, and just saying, Hey, listen, I know I heard a lot of that going on. And you know, I know that we all want this to be a great workplace and you know, I know that I trust you and I want you to trust me.

And in order to trust you, I need to know that you're going to have my back on everything. And I want to have your back on that. Let's talk about that, to talk about that hard stuff, but the reward. Yeah, the relationship and the strength of the relationship, the reward, and that the leader walking away going.

I just taught somebody to, you know, to navigate some negativity, to possibly do that. And I just strengthened a relationship. I talked about something really hard and, and I got a partner. Right. And so intentional. It's hard, right but the reward is just so great. And  I would just, you know, when people do it and they feel it and they see it's powerful. 

Griffin Jones: [00:57:29] You've given us some you've walked us through personality assessments. You've given us the framework for getting leaders on the same page, how to support the leaders so that they can support the next leaders and to delegate. How do you want to conclude with supporting leaders in the fertility field?

 Lisa Duran: [00:57:47] You know, my heart really went when I go into a clinic, I just want to grab them and hug them and just say, you're doing amazing. You're doing amazing because again so many of the leaders out there are just really struggling with feeling like they're doing enough. And so, you know, part of, you know, what I love doing is inspiring them and equipping them first, inspiring them to them to know that they're doing enough and then equipping them to do the things that are going to make a difference in, you know, it's going to help give them bandwidth and help their teams just feel so good about, you know, what they're doing.

And so, I, you know, I think that's, I just want to conclude with I'd love to tell leaders out there. You're amazing. And you know, this time, this busy-ness and the craziness of the growth is just so wonderful. And the season will pass. They'll be some low leveling off, or you'll be able to breathe.

But the growth, you know, the hard times don't produce heroes, the hard times bring out the hero in you. And so I think that I love just watching the hero being brought out in people who've, who it's always been in fight of them. 

Griffin Jones: [00:59:00] I get to become a hero.

Lisa Duran: [00:59:02] Yes I get to become a hero, that's right.

Griffin Jones: [00:59:03] I get to become a hero. There's probably a lot of people that could use that right now. Thank you so much for coming back on us. 

Lisa Duran: [00:59:11] Oh Griffin, thank you for having me. I'm always so honored. I have to tell you, I was talking to a clinic today and I said, I've got to go. I said, I got to quit. I'm on a podcast with Griffin, from Fertility Bridge.

And they're like, oh my gosh, you get to do that. And I was like, yes, I get to do that. So I think you're kind of famous there Griffin so. 

Griffin Jones: [00:59:29] There really is full circle. Thanks so much for coming back on, Lisa. 

Lisa Duran: [00:59:32] Thank you. Take care.

113: Building Out an Effective Referring Provider Strategy

IRH Episode Cover Image (12) (1) (1).png

In the latest episode of Inside Reproductive Health, Stephanie and Griffin explore if MD & DO referrals are still king or have been overthrown by internet resources as top referral sources. Knowing where most referrals come from can help you build an effective strategy to capture more new patients and convert those referrals at a higher rate. We also layout 6 pillars for an effective referring provider strategy that you can either give to your physician liaison to start implementing or outsource to a company like Fertility Bridge. At the end of the day, if your PL does not have a system, you are leaving money on the table.

Listen in to the full episode to learn:

  • The 6 pillars of an effective referring provider strategy

    • Make sure your reporting is in line and cohesive

    • Ancillary services

    • Building the right content

    • Having the right events

    • Outreach of referring sources

    • Converting referrals that come to you

  • The % of patients actually referred by a doctor (and what that means for your clinic)

  • If a physician liaison is needed

  • How to attribute referral sources properly

Additional Resources:

Referral Pattern Blog Post: https://www.fertilitybridge.com/inside-reproductive-health/the-6-pillars-of-the-fertility-referring-provider-system

To learn more about our Goal and Competitive Diagnostic, visit us at FertilityBridge.com


Transcript

Griffin Jones: [00:00:40] On today's episode, Stephanie's on, we talk about our six pillars for referring provider strategy. It's important to get these right before you hire a PL if you're thinking about that, if you're a big company, you've got dozens of PLs, it's important to get this right. And in working in this framework to make sure that you're getting the results that you want before I get into this topic, today's shout out, goes to Dr. Paul Lin from SRM in Seattle, because go Bills, that's why in today's show, we talk about these six different pillars of why it's even important to still address physicians as the referral source that they are, but not to put them on the pedestal of being all or nothing. Talk about the facts beyond that and then we break down each of the six pillars even more finitely. So I hope you get a lot of actionable advice from this episode. Let me know if you need any help and enjoy.

Hi, Stephanie. 

Stephanie Linder: [00:01:38] Hi Griffin. 

Griffin Jones: [00:01:39] Welcome back to talk about referring providers. But before we get into that topic, I do have to tell you that I got a call from someone that I'd never met before. A doctor on the complete other side of the world who listens to the show. And we were talking about other topics, but one of our more recent episodes came up and he said that he agreed with you about the referring wellness providers being listed on the website. And I knew most people were going to agree with you. I even said that in the episode, but I also knew that it would stroke your ego if I brought that up. 

Stephanie Linder: [00:02:15] Yeah, it does. So thank you for sharing that. That's a good start to the podcast.

Griffin Jones: [00:02:18] Yeah, well, now I have to find something to ruin it for you and be pedantic about something to be right about and catch you off guard later in today. But we are in your wheelhouse about referring providers. So I might have my work cut out for me. The reason why we're talking about referring providers is because I've seen the attitude shift from  even when I first started talking to people in 2014, 2015, still many people thought that referring providers were everything that all the good patients came from referring providers, that it was like, it was almost singular as a referral source. And now I'm hearing people say that it doesn't matter anymore. And that's just not true either. I've kind of seen the pendulum swing here and we have some facts. We were doing an abstract.

And then in spring of 2020, when the world started to go, we were going to submit it to ASRM 2020. And then when the world took a turn, I decided that was not anywhere near the top of our concerns at the time, but we did get 250. Responses from REI patients, all people who had done at least one consult at an REI practice from all over the U S and what were the facts that we learned from them?

Stephanie Linder: [00:03:38] Yeah. So we asked these patients several questions and one of the first questions was, were you referred by a physician? Yes or no. And 60% of the REI patients said, yes, they were referred by a physician now that's still a lot, but it's still very far, of course, from a hundred percent. So then we asked another question, okay of all the different ways you can learn about a practice, so physician referrals, online search, you know, online reviews, there was seven or eight options, which of these were the most influential? And what was really interesting MD referrals while still number one, only 21% of people said that was the most influential and what was number two and three was also really important data.

So it, number two was location coming in at 20%. So neck and neck with the MD referrals, and then number three was recommendation from a friend or relative coming in at 19%. So very interesting to look at this data in this way.

Griffin Jones: [00:04:41] So Step another way, 40% of your patients on average are not being referred by a doctor at all.

And that's huge, but it still is really important. It's still 21% of people say that it's the most important physician referrals are the most important influence. Their decision of an REI practice. So that's still important, but it just a lot closer and a lot more segmented than we may have otherwise thought.

And I know that I have to make an important disclaimer here, which is when Stephanie and I say MD referrals. We mean physician referrals. We mean MD and DO referrals. There's a couple of DOs listening that are like, what the hell, man? Sorry. That sometimes really. It's just quicker than saying MD and DO referrals.

And then we don't have to say physician referrals, doctor referrals all of the time. So that's an important distinction to make you have multiple reasons that people are selecting the practice. You do need to know which is the single most influential. And that's why you have to do multi-source attribution.

So many people listening are doing single source attribution. You're asking people, how did you hear about us? I'm sorry. That's a very dumb question. I've talked about this on the podcast before I've argued with Rob Taylor about it. Who's an amazing marketer and you should listen to his episode, but single source attribution is like saying which beer got you drunk after you've had 12 beers. It was the 12th beer that got me drunk. Well,  sorta, but not really. And so when you get the best of both worlds in multi-source attribution He's asking people binary. Did you see or hear us  hear yes or no? What about here? Yes or no. And then all of those different options become the options where you ask of all of these, which is the most influential in making your decision.

And when you do that, you can start to see your patient's referral patterns change over time. So you don't swing from MD/DO referrals are everything to, now the internet is everything. You can see the nuance and the truth is that people  are coming to you from a lot of different ways.

And they're making the decision from a lot of different ways, but they tie in together and you need to be able to see that now that we've shown you, that it's not the most important, but, or it's not exclusively important. It's irresponsible to view it as exclusively important. Physician referrals still are super important.

We're here to talk about that strategy because of it. What are the six pillars that build a referring provider Strategy. 

Stephanie Linder: [00:07:24] So the six pillars that build our strategy around referring providers are number one. You have to make sure that your reporting is in line and cohesive. And we'll talk about that.

Number two is all the ancillary services. That's inclusive of things like semen analysis and HSGs and getting those ready to go. So OB's or any kind of physician can refer very easily to you. We'll talk about that as well. Number three is building the right content and number four is having the right events to promote and support that content.

Number five is the outreach with all of the referring sources and number six is actually making sure and following through that, those referrals actually come to you and convert. 

Griffin Jones: [00:08:10] We're going to go through these six different pillars. And it's important to do that because one of the questions we get asked all the time is should I hire a PL or not?

And that's a secondary question first is that you have to have the system. Then you can decide if you need one person, if it's worth it, having one person working that system most PLs will not be able to just set up a system like this. Some will, some PLs are worth their weight in gold. I think that many PLs are walking billboards and you're straight up wasting your money on them, but some of them are true physician liaison. So they are actually the liaison of the relationship between yourself and the other physicians in your area. They should be treated like gold. They should be compensated well. And if you're listening and that's not, you come work for Fertility Bridge because we're going to be, we're going to be opening up that client operational marketing seat to be its own position.

I might even already have that commercial in this podcast. I don't know if it's done. But Steph gotta be busy managing accounts. So if that's you and you want to do that for multiple clinics, you can come work for us. But for most people, I just don't, they're just not good at they're walking billboards.

So first before we hire somebody to go do that, we have to have them in a functional system. And then you don't have to worry about the walking billboard part, either fulfill the system or they don't. So what is reporting built from Stephanie?  

Stephanie Linder: [00:09:38] So when we look at reporting, we want to be sure there's very specific KPIs that are enjoined with it.

So here, we're looking at two specific KPIs. So what is your new patient volume and what is the total number of referrals, but within that number of referrals, we also want to look at the percentage of attribution, so the patient reporting. So these are the things that we'll focus on and you want to make sure that everything ties up to these two things. I guesse.

Griffin Jones: [00:10:07] And if somebody is listening, Hey, that's three KPI's. It's like, well, oh, well there's two main ones. And one of them gets split. So if your practice or your goals, aren't large enough to do a lot of outreach. Then you just need to measure these two things you need to know, okay, what are my new patient volumes easy?

And then I need to know the number of referrals, but they should be measured against each other in the ways that Stephanie says, if you don't have such big goals for growth, you can more or less stop there. You don't even necessarily need to do the rest, but before you put any substantial effort and resources into outreach, you should be reporting on activity across a few different categories.

So, okay. So we've got the main things to report on volume referrals and how referrals are split up. But once we decide we're going pass, what we're actually going to be doing enough outreach. Then we need to be monitoring the results of that activity. And you could break that up into six categories, which are what Stephanie?

Stephanie Linder: [00:11:14] So there's really three main reports. You will, of course, want to look at the people that are referring to you. And within those that are referring to you, you've not want to, not only want to look at the practice level, but you also want to look at your top 20 providers. So I say top 10 practice, top 20 providers.

And the reason is that there will be some folks that there's only an, a practice of 10 OB GYN, maybe only one is referring. And so they would normally fall down to the bottom of the practice lists.  But if you also look at it for providers, you can target and, you know, change your strategy a little bit to get that top referring provider, to start speaking to their partners and kind of spread the referral, use them to spread the referral patterns within that OB practice.

So that one is the most important, but I was the second most important is who are your targets for those that don't refer so same strategy. We need to look at the top 10 practices that don't refer. And then who are the top 20 providers that you want to target, whether they're in or not in that practice?

The next one is something that I don't see our clients do very often, so I wanted to bring it up. Who do you share patients with, but they have not referred? So all of your patients that get pregnant will need to, well that most will need to be sent back to an OB GYN for care and graduation. Very often those folks that you send back to, if they're pregnant, if they have successful pregnancies, you're naturally having a word of mouth referral and building your brand and reputation.

Hopefully your patient is speaking highly of you. But I was always shocked that people don't look at this list more often, because for me that would be the lowest hanging fruit. Hey, I'm sending patients back to why aren't we starting kind of a circle of referrals. So that would be the third, a report.

Looking at it again in the same way, both at the practice level and then also at the provider level. 

Griffin Jones: [00:13:23] I want to make that distinction for the listener too, because it wasn't immediately obvious when you and I were first talking about this, the referring targeting, not I thought, well, what's the difference between the non referring target at first?

And of course you could use this non referring patient sharing group to inform your target list, but it is kind of different, it's you have people that are, because we know that 40% of people are not being referred by a doctor. Well, they're still going to an OB when they have to deliver, they probably have a gynecologist, and those are the people that you share patients with.

And so if they're not referring to you, you still have that common patient that you can use to build that referral pattern. That was an important distinction. That you made that I think makes sense. If people want to see this visually go to the Fertility Bridge blog, you can see this article where we put in the different columns.

So you can see the different axes between practice and provider and then referring non-referral target, non referring and sharing patients. And so. If you're doing all of these things, you want to record them in you want to record your activity in a CRM. If you have somebody that's out there calling on these people and they are actually working a top 20 and top 10 lists for all of these, that's a lot.

You want to record that activity in a customer relationship management, a HubSpot  or Salesforce, you record the results, meaning who's actually referred in the EMR that, so if you've got your reporting set up, then we can start to look at other things that bring in referrals and what comes next on our pillars.

 


Stephanie Linder: [00:17:44] So the second pillar is ancillary services. And I want to share a statistic that I love sharing with our clients and really is kind of an aha moment is that 30% of patients that see your practice or a referral semen analysis or HSG will return to your practice for fertility consult within one year.

So this is a huge opportunity to get a referring MDs used to your practice. A lot of clinics don't do these ancillary services very well. Painful. So if you can make this process seamless, you will win over a new physician and it's a great entry point to get them to build trust and start referring for that initial consult.

 Griffin Jones: [00:18:27] So what are the steps in order to build that offering? 

 Stephanie Linder: [00:18:32] So we broke this down into four steps. The first thing is you just have to begin accepting outside semen analysis and HSG referrals. Most clinics do this, but I'm always surprised at folks that don't have an HSG machine or don't necessarily have andrology on staff.

So first make sure that's available and offered at your clinic. Second you want to promote that separately separate from, you know, the typical marketing brochure or patient facing brochures you drop off, you need specific content, and we'll get into that a bit later that promotes these services.

How do you send a semen analysis patient? What's the turnaround time? Make that very clear and contents. The third would be to provide a really good service. So your turnaround time at maximum to get these results back to patients. Should be 72 hours, if not sooner. And the fourth is educating these referring providers on what to do with these results.

And this can come in a lot of different ways through content, through events, through consults. I see a lot of people use our advanced providers to share this information back with the referring providers clinics. But it's clear that you educate them and be that source of education so they can begin to build trust and credibility.

So you can begin to build trust and credibility with these referring provider sources. 

Griffin Jones: [00:19:53] Okay, so we've talked about reporting, we've talked about ancillary services. What's the third pillar? 

Stephanie Linder: [00:19:57] So the third pillar is content. So once you've identify these ancillary services, you need a way to promote them as I referred to.

So you need to create this content, but even before jumping into the content, you need to make sure your foundation is set and you know, your brand guidelines are set. If that is not established, you need to work with fertility range, our work with your marketing team to make sure those brand guidelines are crystal clear.

But if that is establish, what you want to do is make sure that you pull out there were the three unique differentiators of your clinic, be of interest to the referring provider. Now I'm not talking about the same three differentiators that you talk about with patients, although it's quite possible they can overlap, but the three differentiators will fall into three categories.

And these three categories are your performance. This is an encompassing of success rates. What unique technology do you do? What happens differently in your lab? Is there anything unique with embryology? The second one will be all about the patient care. So this is where you get a chance to talk about your staff.

You as a physician and the way you communicate with patients. And then the third is the access to care. So are there financing options? Is it easy to get an appointment? Do you take a wide variety of insurance or if you don't, why don't you? So those. Differentiators are he to pull out again that are different from just the unique differentiators that you talk about to your patients.

 

Griffin Jones: [00:24:08] And this is where you can get really creative with things too. It's not just the pamphlet anymore. And I think you've all gotten the idea now that you're seeing so many of your colleagues destroyed Tik TOK and destroy Instagram that oh, doctors really are using this social media platforms. The rest of you that aren't doing that are using LinkedIn, like it's 2010 Facebook.

And so your doctors are in these places, this word is where you use your creative, because you're going to put them in different places, your referral pads, your referring provider page, which should be on your website. You should have a differentiator checklist, a preconception panel, and then how to interpret the essay guide.

And if you want to talk about that last one, I'll yield the floor to use absence. You said often find that's something that's missing. 

 Stephanie Linder: [00:24:59] Yeah, absolutely. So what often happens, not every clinic, but a lot is that they'll send the results of the seam and analysis back to the provider. And the patient is just unsure where to get the interpretation of the results.

Every REI listening to this podcast will agree with this when, how many times does a patient call you and can you give me my results of the semen analysis and your staff is tasked with no, you have to go to your OB for that. And that patient is very confused and that I've seen that lead to bad reviews on the fertility clinics page when it's not the responsibility of the REI, it's a responsibility of the person who ordered the semen analysis.

So the point of this all being is that if you can educate your OBS through written content through a guide, Through a video that says, this is how you talk about the semen analysis results with your patients. This is what a total modal count means. That will just prevent that from happening, which has such a ripple effect into your community, your referrals, your online reputation, et cetera.

So when Griffin talks about, you know, the pieces of content. That one is one of the most key ones that is not really done well in most clinics.  

Griffin Jones: [00:26:17] Should all be cogent with the rest of your marketing. You shouldn't be here's doctor outreach over here. That's just something we do to, we call on people. We invite them out to dinner every now and again, it's part of your brand.

It's part of the content that you create and getting creative is really important to have creative people and in messaging. These things is what helps you get apart from the herd that is doing the exact same things and having the same diminishing returns. So once we've got our content, now we can use that as a baseline for events, which is our fourth pillar, when you've got really good content, then you can create events about that. About those. And so what are some of the different events that people can build upon beyond lunches and dinners? 

Stephanie Linder: [00:27:10] Right. And I'm glad you made that caveat Griffin, because I think a lot of folks just think, you know, for sales reps or PLLs or physician liaisons that, oh, they just do lunches all day long.

And with the advent of COVID, all of a sudden folks are like, oh, there's no access. And they've given up, well, it's time to get creative. It's time to stop using lunches can be good strategically, but it's time. You know, just throwing $400 at the window and seeing what sticks. So the four events that you can leverage is the provider to provider meetings.

One-on-one I know we want to be useful of your time as a provider, but that sometimes they'll go further. Even if it's a virtual meeting than a lunch with 30 staff and no doctors. The second is provider to group visits. This can absolutely happen. And where a lunch strategically would make. But also a lunch does not always have to be done.

It could be something coffee in the morning, a snack people also just want to come and meet the provider for educational value. So if you can come and give them some kind of value or something, they'll learn that they can take to their patients. That's where you'll see the most ROI. The third is open houses.

I know Griffin, you challenged me on this a little bit. People want to see what happens behind the curtain, AK in the lab. And if you have a beautiful space, you have a lab with really cool technology. It's a huge opportunity to show this off, now this would be strategically used with a new doctor, a new location opening.

But I still think they are very useful and the last would be single topic, educational events. So it ties back to what I said is that OB's and you know, sometimes primary care providers, wellness providers are desperate for education around fertility. So if you can say, look, we're doing a virtual event, an in-person event, we're going to talk about, you know, the five markers that you need to look at for your fertility patients, people want to come to that. They want to learn and they want to meet you. So make it valuable. 

Griffin Jones: [00:29:09] All four of these can be turned into they can all be in person, they can all be virtual and go ahead and turn them into a lunch and dinner. If you want to. All I'm saying is the content of each of them should be good enough that you don't have to be buying somebody lunch or dinner if it's not relevant.

Okay. So we're making our way through our six pillars. We've talked about reporting. We talked about ancillary services like HSG and essay. We've talked about content. We've talked about the events that you build. Upon and beyond that content. So what is the actual outreach like? 

Stephanie Linder: [00:29:42] what's important to know as even with the best physician liaison in the world, especially as a newer practice, new location, new doctor, no one can replace the true REI and their relationship with a physician.

So your reputation must be trusted in order to really build and accelerate the referral network. Bottom line is you need to be accessible. You need to be present and you do need to communicate with these referring providers. So there are some places where the PL just can't fit in for you or replace you.

And so this would be allowing residents to do rotations. Just this, the relationships you have with medical schools, shadowing, and coming to visit your practices because eventually those. The OBS of the future. All the relationships that you made in residency are so valuable as you go into your future practice, our into your practice.

And the third would be your memberships in the specialty society. You need to show up to those. That's crucial to make those relationships after hours. And then also it's the grand rounds and the journal clubs. Again, you're educating the doctors of the future. And so what you do now does pay off three, four years down there.

Griffin Jones: [00:31:03] It's this ties into the content via events and everything else. Because as a referring as a physician who is referring, it was being referred to by other physicians. It's your relationship. And the more that you have to build upon and include the rest of your team and the rest of your practice, the more you are extending that relationship of which someone else can be the liaison.

And even though it's not your field, you can kind of get the example from what Stephanie and I do. Many people bought  Fertility Bridge for Griffin because people heard me on the podcast, et cetera. But guess what? I don't manage accounts at Fertility Bridge, Stephanie does and part of the reason that we're able to make that transition is one Stephanie's in the first sales call with people.

So even before somebody becomes a true client or at least in the goal diagnostic, She's in there. And so people are meeting her. If we decide somebody's going to move forward, we bring our project manager into this second meeting so that they're meeting these folks before we even move on. And since you haven't been on the podcast, Stephanie people are prospects. Oh yeah Stephanie, she's on the podcast with you. And so it's even more familiar to people. So you were including these other people with you in the content so that you can distribute the relationship. 

And it's almost like a boomerang with the content, because not only are you  being featured in the content, you're also contributing to it. And you're also getting your orders as far as our philosophy from it. So you're contributing, you're receiving and that's should be true for the entire group.

So all of our points of view, we are really firming out as you've been able to see. So when. Stephanie's talking to somebody there's a lot more for her to go off of Fertility Bridge knowledge than just, oh, this is what I think Griffin would say. And so by you really participating in the content in the events, you're creating a cannon, a Bible, or an authority for which your people can both contribute and they also have their orders to go off of from there. So I harped on that for a little bit, but I just don't think it can be stressed enough. You are the person from which people have the relationship. They don't want to make the substitute if you just drop it on them. But if you bring in the other people and they trust them, then it's a much smoother transition and you can do it too.

From the ways that we talked about the ways that your PL is going to do this is through total office calls, updating the target accounts, they should be also updating the wellness providers. They should be touching these people twice a month. They should be doing the coordination of the content and events, and they should also be checking up on those referrals after those events.

So that brings us to our sixth and final pillar. What is referral? Follow-throughs Stephanie? 

Stephanie Linder: [00:34:13] Yeah. I want, we'll get into that in a second, but Griffin, I want to make a point too, is that when you say, you know, your senior physicians bringing in. There are supporting staff. It's of course it's a physician liaison or the marketing team if they have it.

But this is also great for when you have a new physician, join your practice, you as the seasoned physician or a medical director, bringing the new physician in almost as to say together. Like you can trust them, just like you trust me. And that's also how you start to build a book of business and see the ROI on that new fellow or that new position.

And you almost give your blessing. I think that's really important because that's a really important thing to any medical director that is hiring new doctors. Like they need to get them busy as quickly as possible. And that's one way. But going on to the referral follow through is, okay, great, we're getting people to refer to you now. It's how can I, how do we keep them happy? So there's four key things that you need to do to make sure that this follow through happens. Kind of going old school with the first one is sending a thank you note for that first referral. Now we're talking about people who have never referred to you before and start referring.

So the old school written thank you, notes, Griffin. I know you're a big fan. But it goes a very long way and people just don't do it anymore. So Hey, Dr. Jones, thank you for the referral. The second is just making sure that you are tracking your semi monthly touch points twice a month in your CRM. And you're checking in, you know, this is what's updated with your referral.

This is some new collateral we have, et cetera. The third is the  post console or referral note that is sent back to the OB or primary care doctor immediately following the patient's console. 

Griffin Jones: [00:35:53] Talk a little bit about how that's different from the thank you note? 

Stephanie Linder: [00:35:57] So thank you. Note comes after, you know, you get the referral, let's say, you know, your PL or you as a physician or whomever, it shouldn't be checking weekly to say, okay, Dr. Jones sent me a patient for the first time it's marked in the EMR. Great, I'm sending them a thank you note right away to say this patient booked their console, thank you so much, you know, you don't have to get as detailed, although some people do to say the consult actually in six weeks, we'll keep you updated.

But the post consult referral note six weeks later when that console it happens with the physician. It's the physician's duty to say, okay and they have their specific criteria, again, we don't want to get too clinical, but there's specific criteria that say, okay, this is what they were diagnosed with, this is what we discussed. This is their plan of treating. And maybe they even less, like some of the genetic testing that they're planning to do, each clinic will be a little bit different, but it's basically a note to update the OB so they can keep it in their records to say, okay, my patient, I referred them.

They actually had the console. This is what they're moving forward with, whether it be IVF, third party services, et cetera. So it's a way to keep them updated on their patient. And then a way for them to know that eventually they'll be coming back to them for pregnancy care. So very easy to do this when you're a new practice or you're not busy.

This one often gets pushed to the side as a practice gets busier. And so the key is to create a workflow in your practice that this is templated a bit, or this becomes a part of your operations and it doesn't get pushed to the side. Once you get busy. 

Griffin Jones: [00:37:34] There you go, there are your six  pillars for referring provider strategy, reporting, ancillary services, content events, outreach, and the referral follow through. You need this system before you hire a PL if you're thinking about doing that, if you have a PL or multiple PLs, and you're not seeing the results that you want, or you have no idea what the results are its because one or more of these pillars are broken in the system. If you would like Stephanie and my help and Fertility Bridge's help, we can talk about that in a gold diagnostic, $600. It's quick, it's easy. You can make sure your people are on the right track. And hopefully this podcast was $600 of value just listening to it, Steph, thanks for coming on and going over this with us. And I look forward to getting into more detail in future episodes.

112: Positives & Trade-offs of Academic Medicine with Dr. Amanda Kallen

In this week’s episode of Inside Reproductive Health, Griffin Jones and Dr. Amanda Kallan debate the future of academic REI practices. They talk about the trade-offs as well as the positive future of academic practices. Being a Yale alumnus, Dr. Kallan is the perfect guest to share her view on the operation systems, marketing systems, and scope of practice an academic practice has versus private practice. 


Dr. Kallen, MD, FACOG, is currently a reproductive endocrinologist at the Yale Fertility Center and an Associate Professor of Obstetrics and Gynecology at the Yale School of Medicine.  Dr. Kallen runs an NIH-funded laboratory and has received multiple awards for research, including the Society for Reproductive Investigation “Early Career Investigator” Award for her work on mechanisms of reproductive aging.  Her clinical interests include fertility preservation, access to fertility services for her LGBTQ patients, and primary ovarian insufficiency.

In this episode we cover: 

  • Academic medicine practices’ shortcomings 

  • How marketing blends into the standard of care 

  • Distribution of funding for research

  • Operational differences of academic medicine practices (vs. private practice)



Dr. Amanda Kallan’s Information: 

LinkedIn Handle

https://www.linkedin.com/in/amanda-kallen-58b80959

Twitter Handle

@AmandaKallen

Website URL:

https://medicine.yale.edu/profile/amanda_kallen/


Transcript

Griffin Jones: [00:00:40] On today's episode, I'm a little bit skeptical of the future of the academic REI practice, particularly because of their autonomy or lack thereof. This episode has a great champion though, in Dr. Amanda Kallen from Yale and we talk about her view on the trade-offs of academic practice and the positive picture that she sees for the future.

Before we get into today's episode today shout out, goes to Dr. Michael Hill thought of him because he's at Walter Reed. So this academic topic made me think of him I have no idea if Dr. Hill listens to inside reproductive health, but if you text him, then I might get a text from, and then I'll know today's episode who better to talk about the trade-offs of academic medicine and the positives than a true Yalie.

Dr. Amanda Kallen did her residency at Yale, she did her fellowship there. She's working there. Now she runs an NIH-funded laboratory. We talk about the sacred power of NIH funding, and she's received multiple awards for her research her clinical interests include fertility preservation, access to fertility services for transgender patients and primary ovarian insufficiency.

And we talk about some of those interests and how she's able to pursue them to the degree that she wants to in her practice because of the positive trade-offs that she used of academic REI practice. So you'll see me get into it a little bit with her making her defend it more than I have academic guests in the past, but she does a terrific job.

I hope I was fair. I'll let you decide, enjoy this episode of Inside Reproductive Health.

Dr. Kallen Amanda, welcome Inside Reproductive Health. 

Dr. Amanda Kallen: [00:02:32] Thanks so much for having me. It's great to be here. 

Griffin Jones: [00:02:34] There's someone I've known in my periphery profile, I have never actually known you, we've never actually met, I just remember you being one of the earliest people on my emails. And I don't remember all that happened to you. 

Dr. Amanda Kallen: [00:02:46] I don’t and I, you know, I was, it was an honor to hear from you because  I think, I guess I've been out of fellowship seven or eight years now, but I don't you know, and this is a new opportunity for me, so I don't know how we ended up on each other's radars. Well, I know how you ended up on my radar. I get your emails and I've listened to your podcast, but it's nice to be here. 

Griffin Jones: [00:03:04] It's nice to have you. You're here representing academic REI in some ways. Omurtag, Bortoletto, Feinberg, and a few others. I will admit that it's one of the areas that I neglect. I'm more guilty of neglecting lab business than I am academics but I am pretty guilty with both.

So if there are people that are listening feel that I don't give academic REI a fair shake. You're more than welcome on the show. If you can give it some sort of angle to the rest of the show's themes. And one thing that I like to start with is just why academic. And there's a lot of younger doctors that listen, some going into academics some getting as far away from that as they possibly can.

What are the pros? 

Dr. Amanda Kallen: [00:04:00] Yeah. So, you know, I think the pros are that you can kind of have your hands in a lot of different things.  You know, the caveat for me is that I have only practiced academic medicine. I, like I said, I finished my fellowship in 2014. I joined Yale, which is where I did my fellowship.

So I'm a physician here now. So this is all I know. But that being said one of the things that drew me to pursue academic medicine and to stay was just that I kind of couldn't choose. I wanted to teach, I wanted to be able to continue research. I did bench research, some clinical research, but mostly bench research as a fellow.

And I really liked that it sort of fit I think a need for me to have some time to be sort of delving into a question, being very, hands-on doing my own thing at the bench and then returning to patient care for part of my days as well. And I didn't want to give that up. I had a wonderful mentor, who I could talk about sort encouraged that.

And then from the clinical standpoint, I really liked I loved infertility. That's one of the reasons I went into REI, but I also loved, I think the things that you, that people may see a little less of in private practice I started out with a really strong interest in pediatric and adolescent medicine.

And some of the things you see in that space you know, precocious and delayed puberty uterine anomalies. I did a rotation during my second year of fellowship at Cincinnati children's and I saw a lot of just really cool pediatric surgeries there. And that interest has kind of shifted a bit more to some other clinical interest as well.

But you know, I think being an academic medicine allowed me not to let go of any of those things that I wanted to do. And you know, it's you know, there's other challenges and sort of deciding that you want to do academic medicine and I think making the next step to finding a spot.

But it was really about sort of wanting to keep my hand a little bit in a bunch of different things. I think. 

Griffin Jones: [00:05:53] How much control does one typically have over that, but in terms of their teaching responsibilities, their research responsibilities, their clinical time, how much is that? How are expectations for a set of what that is going to be if people have those interests that while they might be thinking they might be seeing, they might be spending 80% of their time versus how has that delineated? 

Dr. Amanda Kallen: [00:06:21] Yeah. So, at least in my experience, I had a fair amount of, and I have continued to have a fair amount of flexibility in what I have focused my clinical practice on.

Know, I think all of my partners and I see infertility patients right now I have a particular interest in in seeing transgender patients and doing fertility preservation in the transgender population. And that's something that I've been able to really build on and focus my practice on a bit more.

And I've had full leeway to do that. So I think in, you know, and again, every practice is going to be different, but in terms of like the, just the pure clinical piece, like the kinds of patients I see in the work that I do, I've been able to really tailor my practice the way I want to, when it comes to like giving up your time, you know, if you look at a particular week How many days of that week, you're going to be seeing patients or how many days of that week you're going to be doing research or doing surgery or teaching?

I, that part, I think depends on more what else you're bringing to the table in terms of funding. So I have a lot of protected time to do research because I've been able to acquire a fair bit of grant funding, research funding over the last years. More in the last couple of years. 

Griffin Jones: [00:07:30] Are you doing that grant writing yourself?

Dr. Amanda Kallen: [00:07:33] I am. I get a lot of I do a lot of sort of workshopping with people in terms of fine-tuning the grants, but the grant writing is coming from me and it's certainly a labor of love and sometimes just a labor. 

Griffin Jones: [00:07:45] It sounds like a labor because it does.  On one hand, it's like, well, you can, you're free to pursue different things in asterisks.

If you can get the funding and that isn't always easy to do, or I don't know the specifics of grant writing for REI research. What is it like? 

Dr. Amanda Kallen: [00:08:06] Yeah, it's been so, you know, as someone who does basic science research, you know, so if I think back to how I kind of got started, what I had to do, you know, and I think a recommendation for people interested in like basic science research.

What I ended up doing was in my second year of fellowship, going into my third year,  starting to apply for like training grants. There's different ways. Come out of fellowship with a pot of money that will protect some of your time, so that you can keep doing that research. And I ended up with one of those, is called the reproductive scientist development program.

And that gave me about five. It was five years of salary support so that I could actually protect about 75% of my time for research. And about 25% of my time was clinical and that's not, you know, every week isn't like that some weeks are more. 

Griffin Jones: [00:09:02] Sounds like a big grant then.

Dr. Amanda Kallen: [00:09:02] Yeah. And that was the that's the intent of that particular grant it's specifically for like reproductive scientists.

OB-GYNs who don't necessarily have PhDs, but who want to do research that someone else might do, who came out with a PhD. And so that protected my time for about five years. And then there was a span of about two years where I really was cobbling together money from little grants here and there, wherever I could get it.

And you know, at some point my department has been incredibly supportive in terms of the hard jump to make from being a trainee to be, to having sort of independent grant funding. And it took me about seven years. But at some point, you know, having conversations with my department, they're like, listen, you're going to need to take on more clinical days.

If you don't have money to, you know, you got to pay for your time from somewhere. So I think it'd be from grants or from clinical time. And then at the time, the timing was such that kind of right around that time, a bigger independent grant RO1 came through. And so, so for me, I'm able to protect that time because.

Paying for it out of grants. Certainly, I think there are positions where a fellow might come out or someone might move and there might be some kind of like startup package or support for research or time for research, but the kind of the most guaranteed ways to, to pay for that time with funding.

Griffin Jones: [00:10:24] How common is it that physicians are securing their own grants? Is it also common? Maybe the division chief for someone else had secured grants and there's brands lined up coming from somewhere else within the university and a new doctor as an employee, not as a fellow being trained can walk into how common or not common is that relative to them securing their own grant funding.

Dr. Amanda Kallen: [00:10:52] Yeah, I think that's that's definitely something that happens and that's You know, I'd say probably that's a little more common. Because, you know, for example, I'm, I have my own funding, but I have a small stake on a couple of other grants where I do a little bit of work for people here and there.

And those I'm not the PI. Principal investigator, but I, you know, have my name on them and I participate them. And it certainly, I can think of other people in our department who have similar sort of roles in like bigger clinical projects, you know, patient recruitment, grant writing, that sort of thing.

So there's a lot of ways to be in an academic practice. There's a lot of ways to be involved in research that don't have to mean carving out this huge block of time to be standing at a bench. You know, doing basic science experiments, that's just one way to do it. But yeah, certainly to your point there, there can be ways to collaborate and get involved with other practices.

And I think that's really the way a lot of academic medicine and science is going is around sort of building these larger collaborations and working with other people because it is so hard to get money right now.

Griffin Jones: [00:12:00] I want to talk about that, but even, so that's one thread I want to go down. There's a second saying on this one is it.

Not even bringing in other people, but is it fairly common just to say, Hey, I have funding secured for this research, I'm not going to do it myself because I'm working on these projects. But you as the new employee, this is something you want to research. I've already gotten the funding is that common or does that not happen? 

Dr. Amanda Kallen: [00:12:29] Yeah. And I would say that's very common and it could happen in a couple of ways. You know, one of one of the grants that I have, I wrote it that way and I designed it that way so that a collaborator who I work with gets a share of the money or doing a portion of the work that I don't have the time or the expertise to.

And that's, I think true of a lot of collaborative research. Like we, we can't all be experts in everything, but you can identify an expert and see if they'll collaborate with you and give them some of the funds to do that work. 

Griffin Jones: [00:12:56] Those are the questions that a new doctor, academic job to be asking is these are my interests?

Is this BYO funding? Or question two might be, do you have what projects or research areas? Do you have funding allocated for?

Dr. Amanda Kallen: [00:13:15] For sure and I think, and again, cause it's can be hard to secure funding. I think I would go in, if I was interested in research, I would be asking what sort of projects can I get involved with that are ongoing?

What support is available for XYZ project that I'm interested in? What sort of support is there if I am working towards a grant, but don't have one yet? And then time, like what sort of time could be allocated to me to do that one? That would definitely, that would be a question that I would ask.

What kind of collaborative projects or what are people involved with already? That's collaborative and that's available for collaboration. 

Griffin Jones: [00:13:52] So that's one thread that I want to go down is the collaboration with other entities and institutions. First, I want to dive a little bit deeper and build your practice the way you've wanted to mostly, can you talk more about what that means?

Dr. Amanda Kallen: [00:14:11] Yeah. So, you know, I think as a, you know, as a fellow starting out, I would see whatever anyone referred to me.  And so my initial practice pattern was really a little bit of everything. I mean, You know, infertility you know, abnormal, uterine bleeding, uterine anomalies, septums endometriosis, fibroids, acne, you know, kind of a little bit of all sorts of things in both the infertility and kind of the endocrine surgery spheres.

And I think as I've practiced longer I've not only have I wanted to sort of narrow that down a little bit and try and kind of focus more on my own interests, but also I've had to because and this is one of the downsides of academic medicine. You know, if you think about, you know, 25% clinical practices about a day a week, obviously that bleeds into every day.

And I'm answering patient messages and calls every day. And surgery happens on other days and there's weeks where I'm on call I'm in the clinic every single day. But when a patient calls up to book with me she will be offered one, the one day that I'm seeing patients and that books out a fair amount, because it's more limited availability than my partners.

And so I really have had to start to narrow down kind of into like a niche-specific things that I want to do. So I think that I'm fortunate in that the practice has allowed me to do that and then supportive of that. But if I think just in terms of the volume and like the wait times we would've had to do it anyway, you know, I would need to do something like either stop seeing new patients or sort of limit the kind of new patients I see because at some point, you know, it's a balance between, you know, you're trying to do everything. But you want to do the things that you do well, and you want to provide your best care to patients too. And I think that is starting to involve kind of limiting the scope of practice a little bit.

Griffin Jones: [00:16:11] So you've been able to build more practice, mostly in clinical focus. But what about operations, because this is where I get really skeptical. When people tell me, then they'll say it on the show and they're great academic docs and say 'sure' you know, we just have to get approval and we need to go through this.

This is not what I'm seeing happening in the real world. So talk a little bit about operations and when you want to make operational changes you may be communications or image changes or HR types of changes within your organization. Talk about that a little bit. 

Dr. Amanda Kallen: [00:16:55] Yeah. I think what you know, I would agree with what you probably have heard from, you know, others that it, Um, I have less control over those things. And I think, you know, I was listening to your podcast with Eve Feinberg at some point recently and sort of how she was describing like how control changed from a private practice to the academic model and kind of working in a bigger hospital system and how that control changed.

And I have had the same experiences, some of the changes I can make, you know, I can just tell someone, you know it, for example, I basically said I'm going to start limiting my patients. The justification is that my first new patient visit is the end of September.

And that, I think there was no sort of pushback with that big, bigger things do happen. And I think you've used these words more by committee or more at a sort of level above my pay grade. So, you know, staffing changes. You know, I don't necessarily involve my input marketing doesn't necessarily you or  I should say I have input in those things, or I can voice an opinion in those things, but those are not decisions that are made by me.

And in some ways, it's nice to not have those responsibilities. But certainly, I think for someone like me who like to have a lot of control. There are some areas where I have a lot of control and somewhere I I have a little bit less and I think that's the nature of, you know, again, I don't have a private practice background to compare it to, but I think that is going to be the nature of working in a hospital system.

Or an academic medicine system, is there many more sort of stakeholders or decision-makers beyond you know, beyond yourself and I think that's part of why I like to have my research and teaching hats so much is that, you know, I can do my patient care. I do it in the you know, in the sort of within the constraints of academic medicine, but the pros and cons that go with that. And then when I put on my research hat, I am in full control of that, you know, I decide when I want to get up and start writing, I decide where I want to write. I decide if I want to come to the office or if I want to write in a coffee shop that day, you know when we're having lab meetings.

So, it is a nice balance in terms of feeling like I have control over a lot of the things that I do. 

Griffin Jones: [00:21:47] That's what I wanted to ask you some more about is that trade-offs, it's clearly a trade-off and I want, see what's valuable enough to what type of physician profile to accept the trade-off of the lack of control in certain areas.

Because when you're talking about different departments and committees, It's already driving me nuts just from what I learned from you in our 5 minute conversation, but I'm the principal of my company. So I have a proclivity towards a certain way that isn't for everyone. You talk a little bit more about the trade-off

what is worth to you, I guess to say, you know, what, if I don't have controls over these areas, that's okay. Because I'm getting a, B and C more about those. 

Dr. Amanda Kallen: [00:22:36] Yeah, I think I would imagine that in every sort of practice model, there is some relinquish relinquishing of control somewhere. And so in my practice model where I relinquish some control in terms of those bigger decisions that might be made, you know, in with us as a group or, you know, at the level of the administration where I have pretty much full control is in, you know, what kind of patients I see the breadth of patients. I see now, which I don't think is necessarily going to be true in a private model that's more infertility-based.

How many well, I should say how, whether or not the type of patients I see, bring in a lot of revenue. You know, so I don't have to worry if I want to build a practice around transgender medicine or pediatric adolescent medicine, as it relates to REI or fertility preservation, I don't have to worry about it.

You know, how much money that's going to bring in for the practice. I mean, I don't want to say I don't have to worry about it at all, but it's much less of a consideration. So I really do feel like if I want to fit in a particular patient, I can do that. You know, if it's especially if it's something that interests me and I can provide that service for the patient.

And then I think, you know, think, you when you said, you know, liking to sort of be in charge and, you know, having control, I think I'm the, you know, I'm in my lab, I'm the CEO. I, you know, I run the show, I have absolute and total control in that space. And so I think that balance is kind of the clinical piece of things.

The other way, I would say I have a lot of control is just in terms of flexibility. So I can, you know, on the days I'm seeing patients are fairly set, you know, I alternate Mondays and Wednesdays in two different locations. But my other days are really mine to structure. And that could be coming in and, you know, taking my lab through some experiments today.

It could be, you know, especially during the height of the pandemic, writing a lot from home writing from the parking lot at my kid's school, if I have a few minutes, you know, it, there a lot of the work there's a lot of flexibility and not all of the work, but a lot of the work there's a lot of flexibility in both where I do it and the times in which I do it, which for me, I really like, you know, I have a family, I have a five and a half year old son and to be able to.

I'm also a really early bird, but I'll get up at five. I'll write for a while. I'll work on a grant or a paper. I'll think they can just Google. Then I'll come into the lab. And and I'm able to kind of structure my day around things that are important to me, but also get those things done. Clinic days are obviously less flexible.

I'm coming in and starting at a certain time and finishing at a certain time. But that's a real plus for me. I really. I liked being able to do that. 

Griffin Jones: [00:25:29] I think a study on the sleep chronotypes of REIs would be interesting because my guess would be that many of you over-index for that early bird profile? There's probably a couple of night owl REIs. I feel bad for them, you've given us a good picture of the trade-offs of what you're getting and where you're not getting and that's I think that is. A good framework tab going into any position because in society there's a big emphasis on entrepreneurship right now.

It's just, it's not so glamorous. It's not all of the Instagram stuff. I get a lot, but I also give up a lot. And when I'm rooting for people, I try to be very specific about the roles of their seats, because I try to recruit intrepreneurial people. These are people that don't want to deal with the HR. They don't want to deal with taxes or insurance or government or that those levels of responsibility of owning a business and, but they want to own creative. Let's say they want to own digital strategy and those are the people that I look for and it sounds like you were able to strike that trade-off before I move on to the next mini subject, was that explicit when you were moving into this job or interviewing for it or applying for it?

I know you did your fellowship there, so maybe it was a bit more, just came out during your training, but how much of that was explicit as you were pursuing this job?

Dr. Amanda Kallen: [00:27:07] You mean in terms of the, just like, how, like how's the day would be structured or how much would be like yeah. Yeah. It was, I would say it, I knew it was explicit before I started the position because I, you know, I started sort of, I was fortunate and that I was coming out of fellowship with some grant funding and that grant funding mechanism actually specified she has to have X amount of protected time. So that made it really easy\ without that it would have been much more of a negotiation, you know, happy, you know, we cannot, you know, if I was going to a different place, we can offer you 50% protected time for research and 50% clinical or something like that.

And I do think in most places you would leaving fellowship and going into an academic practice or staying. You would want to start with that explicit sort of discussion about what can be offered in terms of protected time? I think what was nebulous for me was that that was always going to change depending on,

where the grant money came from. You know, so I had that time of that timeframe of five years that I had that protection. And then after that, it was, are you going to get any more grants or not? And if you don't how are you gonna pay for your time? And it's going to be seeing more patients. And so,  but yeah, I think for me it was fairly clear what things would, it was fairly clear what things would look like initially and then sort of nebulous. I mean, I remember thinking in a sort of panicky way, like three or four years out, like, I don't know what two years from now is going to look like, because I have no idea if something else is gonna come through or not. So that part is can be scary. But initially it was pretty clear.

 Griffin Jones: [00:28:46] Okay. I want to start to explore the future of the academic REI practice. I have a feeling that the top of the control is going to come back within that context, but I am curious about what you think is going to happen with these partnerships, these purchases that starting to happen because I don't know that I can speak on this definitively enough.

It's just what I'm starting to see, which is, I feel like this new wave of private equity consolidation and network groups or network partnerships, whichever nomenclature, someone prefers is finishing off the job. That the private docs started 25 or so years ago in taking some of these REI divisions or at least, you know, the IVF practice out of it or moving in, but it's their umbrella in the university's room.

Talk about what you see happening there, or if you can't speculate what you are starting to observe with that.

Dr. Amanda Kallen: [00:30:01] That's a great question. You know, I think for someone, you know, like for someone who's in my position who has some protection through funding for research, wherever that comes from, I think that'll continue. You know, I think that. There's always going to be this sort of tension and, you know, this exists even in my practice now.

And I think everywhere when, or as an academic physician or physician-scientist there's always this sort of tension of, should I be doing more research? Should I be seeing more patients and, you know, and how do I split my time? And, you know, when things get busy,  when COVID happens and volume, you know, for us volume dropped obviously, but then picked quite up a bit after, you know, should I be giving up some of this time to be doing more clinical?

Should I be taking call? I take the same amount of calls my partners. And so I think that I think some of that tension will be. Will be sort of resolved or kind of depends on where that, where the protection for that time is coming from. I would imagine. And again, this is just purely speculation.

I would imagine that as practices change if someone doesn't, you know, I the amount of time that an academic practice might be able to give to a physician-scientist or an academic physician to, to devote to. You know, thought work and grant writing and things like that might change unless that time is protected by a funding mechanism.

I'm not quite sure if I'm making sense. 

Griffin Jones: [00:31:43] What about how those funding mechanisms would work in such partnerships, like would these institutions issue grants to institutions that are either owned entirely or partly owned by entities that are profit-generating organizations? 

Dr. Amanda Kallen: [00:32:03] Yeah, I don't know. I know that, you know, I'm thinking of a colleague of mine who has a practice model where she part of her employment comes from a medical school, an academic center, and that portion of her time is her time to do research is her time to do teaching is her time to build the sort of the academic pizza's the REI practice.

And then half of her time is paid for by a private practice where she does that work. And so I could see very easily things turning into something like a practice that was maybe absorbed, where there was an academic focus, maybe turning into something more like that, where there is still time available to devote.

You know, academic medicine because places need fellowships. You know, we need academic REIs. I don't think that'll go away, but maybe. 

Griffin Jones: [00:32:51] But I think that's why it's going to happen. What's the hardest thing for most IVF centers right now is recruiting doctors. We had, this is not a private conversation, we had Mark Segal with US Fertility and he speculated that they might get 14 of the 44 fellows for. Partnership or four groups like that's hard to compete with. And so if you're one of the larger groups, you have the opportunity to purchase, at least the, maybe not the REI division, but you're buying the IVF center and you're starting a fellowship program through their work or now your fellowship program is joint with the academic center. And it's certainly not everything from a recruiting standpoint, not everyone goes to where they did their fellowship. Even if it is a, they have the private or the public, excuse me, the academic route to go either. But but it is an advantage and I think that's my speculation that we're going to see more of that.

Dr. Amanda Kallen: [00:34:00] Yeah, you know, and in my experience, I have not seen, you know, you sort of asked the question of like, will funders want to give money to people practicing in that model, that sort of split model. And I haven't seen that's a consideration like I, you know, and I've read a bunch of grants at this point, and I have never been asked to account, except for maybe on training grants.

I've never been asked to account for how my time is spent when I'm not doing research. What I've been asked to account for is? What have I produced? And what are the resources behind me? So, you know, I have Yale behind me and all of the resources that, you know, Yale can provide and who are my collaborators,  know, that's a big piece of it is who are you collaborating with? What expertise do they bring to the table if you're junior? And I haven't, had to sort of defend, you know, well, I do see patients 25% of the time our practices changing, or it's not, or we're seeing more patients because of COVID-19 COVID is kind of presented a different situation because everyone's research, practice patterns have changed but I think as long as somebody can buy has, or confined the time to get the work done, either by him or herself or in a collaboration, I don't think funders are looking at what are you doing with the rest of your time, as long as you're productive with the time you have and that kind of brings me back to the, you know, what I think is one of the pros or cons, depending on how you look at it of like being in a field or a practice model, like this is I just have to produce, and it doesn't matter,

how or when, or where I do it, I just have to show at the end of a funding year that I've gotten the things done that I said I would do. And so I think when they're deciding, you know, when there's not going to be more funding, they're basing it on did I get done the things I said I would do? It doesn't matter if it's four in the morning when you know, up as an early bird or on a weekend or on vacation, as long as I get those things done.

So I know I sorta took us tangential a little bit, but I think.

Griffin Jones: [00:36:04] Well, I'm with you there. And if I'm being speculative and playing devil's advocate for private or large groups, partnering, buying part of academic divisions, I suspect they would say maybe they even said it on the show and I don’t remember; that they can be grant funders as well.

So they can then contribute from their profits to the research of the Institute. 

Dr. Amanda Kallen: [00:36:31] For sure. And that, I think that speaks to the fact that we are having to be more creative and unique in the ways that we get money, because sort of the, I think the classical or traditional ways of getting funding, you know, you think like in an academic, as an academic physician scientists and the sort of holy grail is to get an NIH RO1 and show that you have this like independent funding, but that's, you know, those are harder and harder to come by.

And that's not the way that a lot of people are getting funded. A lot of people are getting funded through, you know, private grants, you know, through companies or groups, funding their own research. Exactly as you said so, yeah, I think, and I think that's kind of a plus of, I think that's, can only be a good thing is, you know, having more money available to ask and pursue these research questions, wherever it comes from.

Griffin Jones: [00:37:24] Let's talk a little bit about the future in the sense of control as it is now because I really see some institutions having their hands tied behind their backs. And when I started in the fieldset seven years ago, I think it was really just marketing was really just bringing new patients in but over the years, since people have been coming so busy, it's less about bringing new patients in most centers don't new patients in the door, but it, the same things that we used to bring new patients in the door are now used to reeducate patients are used to help them align with self-select, what they want out of a provider to educate them on the process ahead of time.

So that they're not calling the nurse all the time to reset expectations because they're coming in with Uber, Instacart, Airbnb type of expectations or Amazon expectations where everything's instant. So the same things, the same channels and content and styling that we used to do to bring people in the door we're now using to help people.

Self-select better be more educated, have more rapport with their physician and make that process easier on them, easier on the practice and I'm just like I'm seeing academic centers catch up with 2015. Right now, Amanda, congratulations you guys finally got Instagram! Already on the next thing. And so, I even sorry to put Yale on blast, that website looks like it's 2010 and because it's in Yale's website is not you probably I'm making an assumption that you guys can't have your own. So like, I just see the, what I've talked about for the past couple years is what starts off as marketing often just becomes part of the standard of care. It's how you communicate with people. It's the values you stand for, it's how you galvanize your team. 

And so I don't know, that's kind of a rant. I don't know if it's a question, but love to comment.

Dr. Amanda Kallen: [00:39:46] I would agree with everything you've said about sort of how marketing is different in a larger academic center. I think it's funny. I had a patient a few months ago, come in and, know, said I'm all over Instagram and you are, Instagram is terrible. It needs a lot of love and I think you're right.

Like we I think something I'm envious of and also I'm happy to have no part of is how intense sort of the marketing has to be in private practice or often is in private practice. You know, I see my counterparts doing this amazing outreach on Instagram and Tik TOK and videos and all of those things.

 And we don't do that to that degree. I think some people do individually but a lot of that does have to come from Yale rather than, you know, us, I mean, I could do my own thing. But it does of happen at a different level. 

Griffin Jones: [00:40:47] They don't have to do that for marketing to bring in new patients anymore.

Maybe they did six years ago. I think they, prior to that, that they did have to do it to meet those volumes. They don't need to do it for that reason, but now they can do that. And these people will tell you that their patients listen better. They ask better questions. And as one of them has said, it's partly because you're otherwise, it's such a one-way street.

Someone's coming into your office and they're telling you how everything and they're telling you everything about themselves and they know nothing about you and this balances that a little bit, and it also helps to reset expectations important and I just don't see, I don't see academic centers catching up as quickly because they're used to not marketing, but now that we're beyond marketing, they're still behind.

Dr. Amanda Kallen: [00:41:48] Yeah.  And I guess, you know, my way of sort of dealing with, or coping with that is, has become on an individual patient to patient basis. I think I can't you're right. The marketing is not something that I have a lot of direct input in. And so I don't necessarily have a lot of control over how the patient hears about me if it's through. And I know what we're talking about, both new and return patients or how the patient hears back from me. We've got this patient portal you know, the hear back from our nurses, our MAs, but I think what I try to do is deliver that in the visit, I mean, I'm, you know, when I'm seeing a patient I'm and this is true, I think of all docs, but I'm pretty transparent about, you know, myself and my own experiences, you know?

I have a patient who's having a miscarriage. I will share that I have had two, and, you know, and really try and sort of be an open book in terms of that back and forth. So that even if they're not getting it from me through social media, that at least they are feeling like they're getting that from me in the visit.

I think that whenever you have a practice, like ours is structured. The other thing you need is a much better infrastructure slash dedication to keeping those lines of communication open because you know, and I talked about this before, but the other piece is just that the patients can always get ahold of me because there are days when I'm in, in lab and not seeing patients, or it can be hard to get back in for a return visit.

And then that gets frustrating. So I think trying to do as much as I can in the visit to make that to build that connection and then make sure that the frontline people who are working with my patients, the medical assistants, the nurses, the staff to make sure that the patients feel like they have an open line of communication with me, even if there are some intermediary steps along the way, if that makes sense. 

Griffin Jones: [00:43:46] It does make sense and at risk of this belief, belaboring, this point listeners are by like, perfect move on. I'm stuck on this because I think I can thread the needle here. It's the constraint that you're talking about. I have no doubt that you do everything you can to maximize that you have with someone when they're face to face with you, that you are authentic.

I've only known you for an hour at this level, I get that from you. And I don't doubt it for a second. You have that constraint versus other people that they have the same time and they have other mechanisms to leverage that time because we know how so many patients meet a doctor for the first time they come to the clinic for the first time they're a deer in headlights and they can absorb maybe 15% of whatever the interaction involves and this podcast that you're on right now, all of the content that we create about all of our systems about all of our processes is all pretty much for one purpose, which is that when people want to do business, that they actually show up and can receive what I'm telling them and share about themselves.

And they're willing to do that because they've listened to a hundred podcast episodes that listened to my book. They at that point, they're ready to say, okay, we're ready to share with this guy. And then I can get what I need, which is just a fricking business objective all of this whole operation is just so that people will come to me and give me an honest business objective that I can say yes, we can do that.

Or no, we can't purchase like this dance. And I know that it's not the same with patients in terms of skepticism necessarily. But often it's just that like that deer in headlights impact. And if academic centers aren't able to just create content everywhere and do it in creative ways and fun ways and novel ways, then I just see other groups.

Or other physicians at a big advantage for how they're able to treat patients. 

Dr. Amanda Kallen: [00:46:07] Yeah. And I think I completely agree with what you're saying. I would like to see our content creation or marketing. Be even more ahead than what it is, I have seen a big push in the last couple of years in terms of doing that, it's still on our, you know, it's on our website.

You know, you can argue that needs some love,  but I do think there is a lot more attention than there used to be to that and I think at the end of the day, patients will, you know, they'll look for the provider, that's the right fit and if the provider that's the right fit or the doc that's the right fit is the one who has that active presence or that really up-to-date content.

And then they're not necessarily going to come to me. You know, if it's a patient who likes the write-up about me or has, or, you know, I think, and this is really more the case for like my type of practice is word of mouth or referrals. You know, I'm a private OB-GYN, we'll have a patient who maybe has had a good experience and they'll say, go see Dr. Kallen, you know, she has an atrocious list. But you know, give it a shot and that's, I think often, you know, maybe the kind of patient that will end up in my office is a certain kind of patient who maybe doesn't place more value on some other things than the social media piece. And I'm not saying that's not important, it's critically important.

You know, if we're not sort of doing it at the same level that some of the private practices are we do what we can with what we have. 

Griffin Jones: [00:47:47] Well, I'm going to give you the final thought of that. I'm going to be slight, I'm trying, I'm going to try to not be so self-serving I think a good lift for this task for academics started listening is if you were allowed to do our goal diagnostic I know that most academic centers will not be able to move on to the education phase with us. I think that's totally fine, but if they can't swipe a credit card for $600 and sit with their principals of their division to talk about some of these things too, at the very least get attention from their center and that they will get that if they do that and they bring that to their health systems.

They might not go with us after that very likely they won't, but they'll at least get some attention from those people. They will perk up if somebody else is looking at their stuff making a couple of suggestions. And so the litmus test is if they can't do that then I think that is really just a site, one lack of autonomy.

But I do want to give you the final thought and you can wrap the bow on it, however, you want if you want to give one to rebut that idea on control if you just want to talk about the future of what you think academics, REI practice will hold or advice to those entering it. I give you the stage.

Dr. Amanda Kallen: [00:49:14] Yeah, I think I guess I would just sort of wrap or circle back to kind of, I mean, I think that you know, the the issue of control as kind of come up in different ways through this interview, I think,I guess my take home would be, you know, well, I think like any practice, there are some areas, you know, in the past that I've chosen like academic REI.

There are some areas where you have a lot of control. And somewhere you don't and I think it ends up being that some of the areas where I have less control are also less of my time, you know so if I bristle a little at lack of control in some areas at the end of the day, I am seeing patients for this portion of my week.

The rest of my week, I have a lot of control and I have control over, you know, even a fair number of things, you know, my clinical day-to-day practice. And so I think it's I think at the end of the day, it's all about just kind of perception. And if, you know, Where you would like to sort of have the most autonomy because none of us are gonna, I mean, none of us not, that's not true.

Many of us coming out of fellowship may not have it in every aspect of our day-to-day practice. So it's just where you get more of it and I think where you get less of it. And then if that aligns with your goals for how you see yourself practicing for me coming out of fellowship into an academic practice very much aligned with what I was looking for from day today.

Griffin Jones: [00:50:45] And you've had to defend, or at least expound those trade-offs in this interview more than many academic REIs who have been on the show. Probably because I noodle on something after a conversation. I want to dig more into that, or I don't think stuff gets the front of it so you've done a very articulate and compassionate job of explaining and perhaps promoting those tradeoffs, Dr. Amanda Kallen, it's been wonderful to have you on. 

Dr. Amanda Kallen: [00:51:20] Thank you. It's been really nice being here. I appreciate the conversation. 

111: Stay Culturally Relevant by Learning from All Generations with Dr. Angie Beltsos

Dr. Angeline Beltsos on Inside Reproductive Health.png

This week on Inside Reproductive Health, Griffin Jones and Dr. Angeline Beltsos go down a thread of the multi-generational value that happens from colleagues mingling with each other. It’s important for an organization to learn from both the young and old to gain fresh perspectives. Organizations that do this well have many short-term and long-term benefits like being able to recruit well and staying culturally relevant long-term.

In this episode Griffin interviews Angeline N. Beltsos, MD. She is the CEO and Chief Medical Officer of Vios Fertility Institute. She is double board-certified in Obstetrics and Gynecology and in Reproductive Endocrinology and Infertility (REI). Dr. Beltsos is also part of the Clinical Research team at Vios and participates in a number of research projects and scientific publications. She has received numerous awards in teaching and has been honored as “Top Doctor” from Castle Connelly for several years. Dr. Beltsos is the executive chairperson for the Midwest Reproductive Symposium International, an international conference of fertility experts.

Topics discussed include: 

  • Learning from different generations

  • Principles of leadership

  • Leading as an executive

  • Recruiting younger doctors

  • How to be culturally relevant while aging

MSRI Conference: https://www.mrsimeeting.org/


Dr. Angeline Beltsos’s Information: 

LinkedIn: https://www.linkedin.com/in/angie-beltsos-b33a846

Facebook: https://www.facebook.com/angeline.beltsos

Website URL:  https://www.viosfertility.com


Transcript

Griffin Jones: [00:00:00] [00:00:00]Today. I talked with Dr. Angeline Beltsos about what it's like to start a meeting in the field. Hers is the Midwest Reproductive Symposium. What that entrepreneurial venture is like, and the benefits that come from that collegiality and from the networking that allow people to do business. Before I get into this topic with Dr. Beltsos. Today's [00:01:00] shout out, goes to Hannah Johnson, my friend, who's the chief strategy officer at  we're speaking together at MRS. So she gets this shout out. Hopefully she hears it in today's interview with Dr. Beltsos. We go down a thread of the multi-generational value that happens from colleagues mingling with each other, learning from different generations and the principles that, that takes into leadership in leading as an executive and also following by learning from the next generation, this turned into be a lot more philosophical than I was necessarily thinking, but we talk about the short-term benefits, like recruiting docs. It's going to be a lot easier. For you to recruit doctors and staff doing some of these principles, but also the longer-term headier stuff of being culturally relevant well into old age. I hope you enjoy this discussion with Dr. Angeline Beltsos.  Dr.  Angie welcome back to Inside Reproductive Health. 

Dr. Angie Beltsos: [00:02:04] Thank you for having me.

I'm so excited to be here. 

Griffin Jones: [00:02:07] The first time you were on, we talked about your entrepreneurial tendencies. We're going to talk about those same tendencies today, but applied to a different venture. Last time we talked about the Vios empire, what it was like to start a group, but this time I want to talk about a different venture that you started as far as I remember, and that is the Midwest Reproductive Symposium. That is an in-person now a hybrid in-person and virtual meeting, but it had been in person for years. And I want to talk about how that got started and what possessed you to do it. So let's start with what possessed you to do. 

Dr. Angie Beltsos: [00:02:47] Well, I had just started career after fellowship. It had been a few years and varying pharmaceuticals. One of the reps came and said, why don't we do a meeting in Chicago? We had the ASRM meeting, of course the national meeting. And then, California. We have the Pacific coast fertility society. And they said, why don't you do a meeting in the Midwest? And we can call it the Midwest Reproductive Symposium, the MRS meeting. And, here we are several years later .

Griffin Jones: [00:03:24] But why did you want to do it? I mean, reps probably come to you with half-baked ideas all the time. I've come to you with half-baked ideas before, so you could turn around, turn away or launch into any of them, I suppose. Did this one seem good enough to you? 

Dr. Angie Beltsos: [00:03:39] It seemed like filling a void. Although a lot of people go to a big meeting, like the ASRM meeting or SRA with thousands of people. And we get to see all our friends and learn the latest. It's also ironic that when you're in a big meeting, sometimes you don't get as much out of it. You don't get to. Actually speak with some of the thought leaders and, make new friends. And so the idea of having some of the thought leaders, not only in Chicago, cause we called it the Midwest meeting, but it was actually the place where it was held, not where all the attendees came from. And we had , immediately a national attendance and really some of the thought leaders in the world. It's an intimate setting. One in which we. Do have it at the Drake hotel where we have probably a max of around four or 500 attendees with that though you have a certain vibe that comes with that. There's a lot of opportunity to not only learn science, which is very important and be motivated to take some of that. Back home, really to change how people practice fertility and keep it modern and fresh and forward-thinking, but also to make a friends and colleagues that last not only for that meeting, but for a lifetime. So when they came up with it, that was sort of. Be relevant. 

Griffin Jones: [00:05:15] And you're right. People do come from all over. That's a nice thing about it being in Chicago is it's kind of easy to get to Chicago from anywhere if you're in the U S Chicago central. And then if you're not in the U S well, it's only an hour or two more for you probably than it would be any of the other major cities at most. So it's really central place. You got people from all over, but at what point did you realize that this was gonna be. You taking it on.  Did you know that from the beginning or were you thinking that, okay, Faron, go ahead and do this. I'll come and be the token REI. And what point did you realize that this was your baby. 

Dr. Angie Beltsos: [00:05:53] T minus,  six to nine months when the whole thing started, it was going to be something that I organized. With the, you know, some of the faculty that was with us and some of my colleagues, but they were like, all right, you're in charge of this, go at it. So we, I went around and I was like, who's really a heavy hitter today. And who are some of the thought leaders in the United States? And they were like, well, call them all up. See if they'll speak. So one by one, I called each person and everybody said yes, which was really surprising. I was like, hi, I'm Angie, do you want to speak at my meeting? They're like, sure. Hold on a second. I was like, Hey Richard, Scott, will you speak at my meeting? They were like, one moment, please. This is Richard. Like, yes, I will. I'm like, oh, okay. Bill Schoolcraft, will you speak at my meeting? Yes, I will. I was like, okay, then see you in June. 

Griffin Jones: [00:06:53] So this was 2003. That was the first year? 

Dr. Angie Beltsos: [00:06:58] This was. I guess it was '03. Huh? 

Griffin Jones: [00:07:01] That's what the website tells me that's before my time here. So I'm going to take the website for its word now, at what point did you start to build like committees and have recurring people in the beginning? It's like, okay, I'll call the people I know and ask them to be speakers how did that turn into like you have other people planning specific. 

Dr. Angie Beltsos: [00:07:24] Parts of it. Yeah, you know, it's a great question. We started with a meeting planner and me, and then she said, well, why don't you ask,  you know, some of your friends and colleagues who they think would be really important and relevant, so there was sort of this informal committee that she and I talked about and an organized, and she guided me for the first five years, Ferring was exclusive as a sponsor and they were. You know, an unrestricted educational grant. So they weren't really involved in the topics at all.  And you know, very much saying, find the best speakers, the best topics. So really high quality, I think. Things that were coming out as new things to consider doing in, in our field. And we had we had a blast, but over time, I would say the first year we had some of the speakers like Barry bear and bill Kerns, they said, why don't you ask them to be part of your committee? So we were about three or four people in the first, several years that started to help think through this. And then the people that were involved also came up with great ideas. They said, well, why don't the nurses don't have anywhere to go? Why don't you have a nurse program here? So we started the nurse practicum and then, a lot of the business minds in industry said you don't have really anywhere for business people to meet.

Why don't you do a business program? So we came up with a business minds. And this one , person was really interested in mental health and said, there's no place for mental health in any of these programs please. Can we add it in? So we started the mental health program and we thought there's no better place.

If you've got all these incredible people together, why not have some of the students of fertility? So we added in the. Reproductive endocrinology and infertility the REI fellows program. And they've been a strong part presenting their research and getting to know them. And it's funny because in the beginning, the students are they're learning, but then soon the student becomes the master.

Griffin Jones: [00:09:52] So, how do you get some of these people to keep coming back and chairing their specific segments? Because some of the people you've had for years and years. So how do you keep reeling them back in? 

Dr. Angie Beltsos: [00:10:04] I think that when you want something to be sticky in your life and you want to keep people engaged, it can't just be about black and white things.

There's some very important things about a meeting and. Only what you're saying, not only what you're doing, but how you make people feel like the Mio Angelo quote. And I think that becomes very important. So we are so intentional to make sure that people like Griffin Jones when they come to the meeting.

Yeah. You learned a lot, you made some new connections, but you also. Had a blast, hopefully, and music and time to socialize is very intentional people often say, oh, well, you know, why do you have all that in the meeting? But it's so important to make people feel good about coming back. 

Griffin Jones: [00:11:03] I think it's one of the things that binds all of that together.

Like you said, there's a fellows track. There's a business minds program. There's a nurse practicum there's for program for doctors and scientists and the size of MRS, and the social events bring it all together. It's a very good place to build relationships. I love ASRM. You can get more business done in four days of ASRM than you can four months on the phone.

In many instances, that's true for almost everybody across the field, but there's something about MRS. Where it is very good for building relationships. When I think to some of the strongest relationships that I have with docs and with other people across the field, it started there in Chicago. And I think it is this.

It is because you can go to one of the mental health talks and then you can jump over to another track if you want. A lot of people do the same track the whole day, but there are, there is so much programming for everyone. And then it's all tied in at the end of the day and Chicago. In June when it normally is in fantastic this year, it's going to be September, which is the other end of fantastic for Chicago weather is why you're not having it in June.

So let's talk a little bit about the changes that you saw. COVID happened. I mean, I imagine in early March you were kind of like everybody else, oh this isn't going to affect us. It's too far off. And then two days later you're like, 'no' it's definitely gonna affect this one in the next one. What was that like adjusting for COVID? 

Dr. Angie Beltsos: [00:12:38] I think like we were at Vios. ,sometimes it's good to be lucky. And we had thought very importantly about being nimble, being able to switch gears and pivot quickly. So when. All of this started to unfold. We didn't know if it was going to be two days, two weeks, two years, you know, sitting here talking to patient by patient, but for the meeting, we also felt it was going to be very important to be relevant and to continue.

So we were the first meeting to go in the fertility world to go into a virtual setting. And we just said, pivot and go. So we did our meeting in June. By zoom or by a video conferencing. And it worked out beautifully.  All things considered. We had great attendance and really used our program that we had anticipated.

And you used pieces of it. You can only get so much done. That is video sitting at your desk compared to being in person. So what we did is broke it into three parts and divided the typical conference into three parts of the year. The first one was during the meeting itself, but just not at the Drake and then play that out through the year.

So I think our sponsors really supported us as well to say, just go at it and continue to use our funds to produce. Meeting and do it virtual. So we did all of that for 2020. We did the whole program. 

Griffin Jones: [00:14:17] What's it going to be like this year in 2021? 

Dr. Angie Beltsos: [00:14:19] This year, the date of our usual program that like you said, it's usually in June, we are going to do virtual, just the board review course, which is going to be amazing. It'll be June 11th through the 13th, all virtual, but this is going to help people that are students, medical students, residents, but particularly the fellows who are preparing to become board certified. And during that program, we'll be diving really deep into the science and our real program for the Midwest Reproductive Symposium International 2021.

We'll be in person September 21st through the 24th, we will have also a virtual component to it. So it will be hybrid. And we're really excited about that as well. 

Griffin Jones: [00:15:10] What do you think. Should be virtual as we move beyond COVID, as we move beyond like the, that forced shutdowns. Right? What should be virtual moving forward?

2022 and beyond. And what should be in-person 2022 and beyond. 

Dr. Angie Beltsos: [00:15:29] You know that's a great question. We were talking with some of our brilliant board members. And like you said, are what started as our small group has now turned into, really amazing people that are part of our organization. And we talked that we wanted international, component with Scott Nelson.

He's our international board member, who is at the University of Glasgow in Scotland, but we have board members from coast to coast and. What we realize is that in different locations? And different time zones in private practice and academics. You have to now have this virtual component because people may not be able to attend, but they want to hear key lectures.

So there's going to be a couple of different options. One are just being able to get like a little appetizer, some key lectures. And then there's also the ability to watch the whole thing from around the world. And we expect that we'll have people from different continents participating now. And I think that's, what's really cool about it, but like everything else, there's nothing, that people don't enjoy more than being able to see each other.

Now, having some, coffee together, cocktails, you know, and like you said, building up relationships in person. So that's also going to be available. And I think that hybrid approach will be what we do with our patients. It's what you're going to see in business going forward, as well as,  these meetings.

Griffin Jones: [00:17:06] Do you ever see the hybrid programming shifting so that certain programs are all digital and then certain programs are all in-person. 

Dr. Angie Beltsos: [00:17:19] I think what there is in life, there is about 80, 75, 80% that you can communicate through an entire digital approach. And that includes some of the relationships we have and then the water cooler kind of effect, or the in-person contact will be missed if a hundred percent of it is done digitally.

So I think you can get a lot accomplished, with the video conferencing, but I think. That doing everything a hundred percent video, you will also miss some important things that happen when the cameras shut off. 

Griffin Jones: [00:18:05] I think so too. I wrote an article about this, right? As everything was shutting down, I wrote it in March, 2020.

It was like soon as they canceled PCRS, I fired it out. And it was an article about what I think should be in person. What I think should be video because our company has been remote since you've known me. We've always been remote, but I will tell you. It hurt even in, COVID not being able to get together, even though my project managers in Memphis, my operations managers in Nashville, my digital strategist is in Colorado, a account managers in Miami everyone's everywhere, but we still normally get together a couple of days a year.

In-person to do the stuff that we need to do in person, which is the major long vision strategy and the personal bonding, all of the execution we can do over video. So I wrote in that article, this is what I think should be in person. This is what I think should be done. Video. I think a lot of the speaker stuff in the future can be done via video.

I think the in-person workshopping and and the networking, is what the in-person meetings have to offer. So why don't we just start building those programs,  around that way? What do you expect to see this year in 2021, knowing that it's people have kind of gotten the habit of all, it can do it from zoom, but they've also, they're also kind of starving though.

So what do you expect to see this?

Dr. Angie Beltsos: [00:19:36] Well, we hope that some people will. Be able to, come from around the world and participate via zoom and via video conferencing. So I'm very excited about that. And I think that some of the key lectures you can present that. On a screen. But I think the dialogue that happens back and forth and seeing the audience in person is,  is also priceless.

We do workshops, which I think is also unique where we break the whole audience into groups that dialogue into kind of a small group, a round table kind of discussion on different topics. And I think that would be you know, better done. I think those kinds of things could be better done in person. 

Griffin Jones: [00:20:27] So those types of things, I see that as the future of,  in-person events.

And I sometimes think that events like yours are better poised than some of the larger ones for that reason, because it's kind of built for that. It's built for that in person, that in-person. Type of relationship building and yeah, I, you know, like I said I'm, I'm a hundred percent pro-zoom pro doing anything that can be done electronically.

Electronically, Fertility Bridge has never had a home office that said, I also don't think I ever would have built the relationships that I did had it not been getting to meet in person, even if I, sometimes there's lots of relationships that I have. Digitally first, but then I meet them in Chicago. I meet them at MRS and that puts a certain icing on the cake that is irreplaceable. 

Dr. Angie Beltsos: [00:21:19] Irreplaceable.

There's a great book called The Art of Gathering by Priya Parker. That was a gift from Hannah Johnson and it's how we meet and why it matters. It's a great book for those of you listening, who do care about meetings and how we meet and whether it's your family, whether it's your business, whether it's a big conference, it really is important to consider the elements that allow it to be successful and how you want that flavor.

To be what you want to accomplish. And I really appreciate you, Griffin inviting me to talk about, our meeting, but what the elements are. I think that intimacy is very important and people start to become more open in certain size groups , and numbers. So there are certain things we accomplish in the big symposium, and there are things that you get out of it by being able to speak and dialogue with your colleagues.

 Howard Jones God rest, his soul had, said some really important things to me about the MRSI meeting. And for those listening, he was one of the fathers of IVF in the United States. He had the 13th IVF baby, born, in the world, but he. He was saying that when you have a meeting, make sure that most of the meeting is your Q &A and talking, let the audience talk to each other.

Don't spit out all these lectures and, you know, we invite these brilliant people to give lectures with 75 slides in 20 minutes, but they really, you know, that, that idea of throwing out the topic, the latest. It's points of what's relevant and then let people talk about it. And that's when you really take things home.

Griffin Jones: [00:23:18] And do you have the opportunity to do that? Especially as a breakout speaker at MRS people always come up to me after MRS. Specifically. And it's great too, because if I need to talk to one person because they got to me first, say, Hey, I can see you at the cocktail hour later. They don't just, they can't just, they don't just lose me in the ether.

And that's. Maybe that's the Je Ne Sais Quoi of MRS 'cause I'm thinking I love PCRS. I love CFAS. And those two are smaller meetings that are very collegial and I really liked them. And I'm thinking, what is the Je Ne Sais Quoi of MRS? And I think it's partly Chicago. I think it's partly you Angie. And I think it is, multi-disciplinary focus, which isn't is true for the other meetings, meeting the size, meeting the social events. And I was talking with one of my employees today who's really advancing in their career. And I said to them, Part of being a senior person is even when you're in your role, you know, how you play into the rest of the picture.

So I think even if you're a mental health professional, and that's your thing, knowing what the doctors and scientists are up to right now is really important. Even if you're a doctor, knowing what the nurses are up to right now is really important. Even if you're a nursing manager, knowing what the business minds are up to right now is really important.

So I hope that you. Continue that streak at MRS as it evolves. 

Dr. Angie Beltsos: [00:24:48] Well, I appreciate that. And I think,  the other piece of all this, as we try to play a lot of music during our meeting before, during and after, and, when we talk about , you know, what makes things attractive is that people learn really well.

If you activate both sides of the brain, the right and left, and there's a lot of scientific studies, how important music is. So, you know, The music, in the very beginning, between every speaker and it activates that side of that art side of the brain the other , relaxing side. But then you throw in some hardcore science and it's supposed to really help with, feeling really good about things and having fun, but also learning.

  Griffin Jones: [00:27:50] So now that it's established and now that you also have an established practice group, what do you think you get out of it? 

Dr. Angie Beltsos: [00:28:00] This has it's a really great personal question for me. It changed my whole stratosphere. My the course of my, my career. It changed the whole direction of who I am and how I practice medicine, who I talk to in a moment I wasn't doing, you know, I was just. One of a new grad of doctors in the country. And suddenly I was friends with the thought leaders. And from there you get invited to give a lecture in Canada and then you meet, go end up in Europe. And in Europe I met people from Australia, the president of the Australian fertility, and then all of a sudden you're in, I was in.

Australia giving lectures and from Australia met someone and I was in China. So I literally went from being this little. Chicago doctor organizing a meeting and through it, I became, I made friends with people all over the world. People that showed me the backside of the kitchen. You know, you go to these great speakers, the, and they take you home and they invite you into their world and they teach you how to run your business and things to do and mistakes they made.

So. This out of all the things in my career, as far as fertility goes, this hands down changed the whole course of my life. 

Griffin Jones: [00:29:31] It's funny because you're talking about the history of you getting plugged into other people through this. My experience is you plugging in other people through this, like myself included, but I think of, you know, not to blow up your spot, Angie, but you are better at your fair share of you get more of your fair share of younger docs in recruitment than many people do.

And I think part of the reason for that is. Accessibility.  And I think  MRSI just a megaphone of accessibility. 

Dr. Angie Beltsos: [00:30:06] Yeah. It's been a, it's been a gift. I've been very blessed to have been given this opportunity to fund. I mean, the money that. Came through to, to organize, had to be properly managed. And through that you create a, hopefully a platform and the younger people that participated as fellows have become friends of mine.

And some of them  have joined Vios and some have been. You know, colleagues in the country and in the city and it's been awesome. So I think that was correct to that. We've had a chance to make new friends in a variety of age groups, not just the older , genre of thought leaders and people that invented what we do, including Louise Brown, the product of, thought leaders, but also the younger group.

We've become,  had that opportunity to get to know. So you're right. It's been a gift. 

Griffin Jones: [00:31:10] Well, let's end this thread of cultural relevance for a second, because I'm obsessed with it. I stay up thinking about how I'm going to be culturally relevant when I'm 88 years old, it's something that I really obsessed with.

It's like longevity meets sustainability meets just something I intrinsically really enjoy. And I see some of the advantages playing out for you. And I think that might be a gateway drug for the people that might not just geek out on it as much as I do, but if they can see yeah, you are the perfect case in point.

So, but if they can see the tangible benefits of what you've done, I think so many people are having a hard time recruiting doctors right now, recruiting younger staff and. One of the ways that you've been able to do that. As you give fellows a platform, you, they always, they know that they can call you.

They know who you are. That's really important. They see you. Content. And so maybe we can extend some of this to other people. They're not going to go off and start their own meeting because it's way too much fricking work. But even if they were a chair for one of your programs, even if they were a speaker at ASRM, that's more accessibility.

So maybe we could just talk about how that accessibility to the younger generation helps you stay relevant to them as they start to take over the reins. 

Dr. Angie Beltsos: [00:32:36] Yeah, I think that's such a fascinating topic of cultural relevance. You know, it's like a moment ago, sick was kind of a bad thing, but you know, that is so sick really.

Is that a good thing or a bad thing? Oh, I guess it's a really cool thing. And in the moment you become, you know, all of a sudden the words people use and the way that they approach life, but you're, You've got to be a little willing to always change. And human nature is the opposite of that. Don't get stuck in, you know, your old ways.

Try to learn, try to be a chair and take that stuff home and be a little uncomfortable. I think that's really important. Remember that when we lead the group, That we have to have humility and we have to be part of the group and let the group also have opinions and decision-making and feel valued and appreciated.

And it is a, very delicate balance. Isn't it. 

Griffin Jones: [00:33:43] Tell me more about that balance. What makes it so delicate? 

Dr. Angie Beltsos: [00:33:48] Because as the. Leader of an organization. You may be the medical director, some of the audience members, they may be trying to hire or keep, you know, these young, vibrant physicians. And they're going to be people that come and go for a variety of reasons, but we have to look in the mirror.

We have to be accessible. We have to be, a teacher and a student. That dichotomy has to exist. You have to be a leader and you have to be allow the others to lead you. And so there's this, this balancing act and your people in your life will be your witness, good, bad, or ugly. And they're going to talk and social media today.

It's just like our customers. They're talking about us. They're  explaining, you know, the day to day activity. And so you have to listen to people's dreams and their aspirations and support them. And we're not perfect at it. God knows. There, there is intent there, and you have to figure out what you believe in , and how you're going to do this.

You know, the MRS is a charity to me and Nelson Mandela says the most powerful way to change the world is education. And so many people helped us get to where we're at and I cannot repay them. You know, the people that believed in me and gave me a chance. Those, I can't give them money. I can't give them something to help them do what they did for me. The only thing I can do is turn and give forward, right? So we give to the next generation, the next people and the people that are attending to, provide the best care to people that want to have a family. If you just go back to your mission of why do you exist?

Why do you do what you do?  Trying to create a team around you and that cultural relevance is,  is always to be open minded, I think, and open your heart and your mind be accessible. And I think. Wanting to listen and be friends with people from all different walks of life. 

Griffin Jones: [00:36:04] I'm going to push back on one thing you said, of course, like I'm just like riding the lightning of 90% and I choose the one thing that I'm gonna push back on.

But one thing, the one thing that you said. Is that I can't pay them back. And for some of them, that's probably true. Maybe some of them are gone or some of them, you just won't have something to offer that they need in the rest of their careers or lives. But I think many of them, you are in a position to pay back that those that helped you get to where you are now.

Some of them may be being put out to pasture. Oh, we've heard from him. We got it. We don't need his ideas anymore. And you're in a position now to say, no, I really remember this person helping me out. I'm going to give them a platform. I'm going to help them maintain their cultural relevance because they helped me and they are still relevant to me.

So I see that happening and I see that. I remember the people that put me on in the beginning. And now that my cohort is, and we're not in our early twenties anymore. Angie, now that we're in our mid thirties, late thirties, and we're starting to be the executives and at the very least the director level and the owners of companies, the people that it's not just returning a favor either.

It's hey, I learned a lot from this person and I think they still have that value to teach. I think you can repay some of them. 

Dr. Angie Beltsos: [00:37:29] Yep. You know, I think about, the opportunities that we got at all levels. I remember. The person who gave me a scholarship to college, you know, the, like you said being thoughtful about that and reciprocating can be very powerful all the way to someone who spoke at my meeting and gave me, knowledge that helped me hopefully get one more person pregnant, that I tried something new and different and being grateful to them and honoring them is , is really important. 

Griffin Jones: [00:38:06] This is so meta because the topic that I'm speaking about at MRS this year is how to manage millennials and gen Z in the workforce in so Meta, because , at least some of what I've learned has been through interactions at MRS. And you're talking about this balance of leadership and following

I'm not a new agey person that says, oh, just listen and do whatever they say no, at the end of the day leaders lead, but leaders. Based on information that they see and they get that information by asking and interacting MRS is an awesome place to do it. And a good exercise that I do every year is it started with your kids.

Angie 1: because I just think your kids and their friends are really well raised. And anyone that wants to talk trash on how kids are raised the other day. Listen, most of the time, I might even [00:39:00] agree with them, but there's always examples to the contrary. And that's your kids and their friends and looking people in the eye taking.

 Ownership of whatever they're supposed to be doing there. You put them to work there at the conference and they're doing work and I love taking your kids and their friends and whoever the interns are out to lunch every year. That's a tradition. I started a couple years ago and. If they're there, I'm going to do it again.

Well, I enjoy it too though. Angie, like I, I just watched them. I watched what they go out. Like I watch what they go out on the dance floor too, versus what we got on the dance floor to, I watch how they interact with each other. I watch my own, my one rule for them when I take them out, is I, and they all.

Cause you and Nikki tell them before I've even taking them out. I say, what's the rule. They said, no cell phones at the table. I go. Right. And so, so then I just get to talk to them and, and see what they're interested. And the reason why I'm saying all of this in regard to your lesson about leadership and following is because iIf I want to be able to lead this cohort, when they're in the workforce in eight years, I need to know their language and I'm not just going to learn their language. If I start the moment that I need to learn the vocabulary, if I'm a bit invested in how they're growing up and how they're finishing high school, going through college, entering the workforce, picking up the things that they're doing along the way, I'm going to be able to speak their language.

A lot more fluently and be able to tell them no, shut up young person and listen in the way that they'll actually understand and doesn't come across like that. And a lot of that I get from MRS. 

Dr. Angie Beltsos: [00:40:43] Well, thank you. That's a funny part and a funny story I had, you know, these were always so careful we get as a charity.

Basically sponsorship and donations to try to run the meeting. And people don't want to go to kind of a small, simple hotel cause they want to be able to enjoy the space, but that all takes money. So I called one of the meeting organizers at a company and they said, I said, how much would it cost for someone to come and check people in and hand them their badge?

And they were like, that's $45,000 and I go, you gotta be kidding me. I was like, all right, kids get dressed. And I thought, you know, what a great way to have for a high school student. To have some exposure to a professional event, be responsible for the happy customer and the customer. That's being a little difficult.

And one of them. You know, they still quote today was one of the doctors that said, this does not say doctor on the top of it can make me a new badge. And I was like, yep, this is customer service. You know, people want to make sure that they're honored and they're whatever. And they had, and I want you to greet people and welcome them.

And so we ended up, Having the high school interns have their exposure. A lot of them put them on college applications and they said when they were applying, they used it as some of the things that they wrote about their experiences. But also for us, it allowed us to, have some young people be very kind and welcoming and hang out with Griffin Jones, but also was a lot less expensive than the, the company that wanted a big chunk of change to greet people. So. 

Griffin Jones: [00:42:38] Well, I'm glad that economic way pushed that forward because they have a lot to learn, but there's also a lot that we can learn from them. That's one of the multi-generational values of, I encourage other people to do it as well. You have to be able to speak the language, or you're going to get put out to pasture? There's another episode that I did with this. Almost on this theme with Hannah Johnson, who I'm speaking with at MRS. This year on millennials and gen Z, but it's the flip side of the coin too. Dr. Beltsos how do you want to conclude on MRS and collegiality and, or multi-generational collegiality in the field and tying that all together.

I'll let you put the bow on that with final thoughts. 

Dr. Angie Beltsos: [00:43:28] Thank you for inviting me to speak at your podcast. It's always an honor and a privilege. And in that same context, I think the Midwest Reproductive Symposium International that I at the end is supposed to cross boundaries.  It's supposed to take us that are wanting to be taught from the learned to be open to different ages, approaching similar topics.

Different perspectives. So we hope that the audience that is listening will bring themselves and their friends and their colleagues to our meeting. Not only this year, hopefully in 2021, but in the years to come. And that the meeting allows us to grow, stand on the shoulders of giants. Be a little uncomfortable with taking some of the stuff home and trying something new and continuing to be open to growing.

And I always ask people no matter where, how old they are is what do you want to be when you grow up? You know, as , we look to the future and, I think. That spirit is embodied in MRSI, so with that, I appreciate again, the opportunity to be with you to be,  motivated and inspired. 

Griffin Jones: [00:44:59] Angie, I'll see you at MRS, in September Inside Reproductive Health listeners. We hope to see you at MRSI in September. We'll have a link in the show notes, and we'll send that out with the email Dr. Angeline Beltsos thank you very much for coming back on to Inside Reproductive Health. 

Dr. Angie Beltsos: [00:45:15] Thank you.

What Affects IVF Conversion Rates?

In this episode of Inside Reproductive Health, Stephanie and Griffin talk about IVF conversion rate, the six areas that affect it, and the order of importance of those areas. This episode lays out the Fertility Bridge system and methodology for doing for increasing IVF conversion rates. We can't tell people how to act as clinicians. We're just sharing with you the patterns that we see.

You’ll certainly get some food for thought as we discuss:

  • Follow up best practices

  • Pre educating your patients

  • How to share your wellness providers

  • Physicians’ styles and their effect on if a patient moves on to treatment

To learn more about our Goal and Competitive Diagnostic, visit us at FertilityBridge.com


Transcript

Griffin Jones: [00:00:40] Mo' patients mo' problems today, we're going to talk about IVF conversion rate and the six areas that increase it or decrease it depending on if you're investing in it or neglecting it. So we're going to lay those out for you in order of importance is the Fertility Bridge episode where we go over our system and our methodology for doing that.

But you can apply some of it right now. And I have Stephanie, who is our director of client success. Stephanie lenders, back on with me. To go over these six different areas and to talk about IVF conversion rate on the whole, the last episode got a lot of traction. So if you have particular questions, go ahead and send them to us.

We can use that for future content. And if you really disagree about something, especially the part with physician. Presentation, let me know that I will happily have someone on the show that has a counterpoint of view. We can't tell people how to act as clinicians. We're just sharing with you the patterns that we see in order of importance.

So I hope you get some food for thought and enjoy this episode on IVF conversion.  Hey, Steph. Hi Griffin Jones, I'm looking forward to going into today's conversation because last time we had you on, we were talking about the entire third phase of the fertility patient marketing journey, consult to treatment that got a lot of opens.

When we sent the article, a lot of people emailed us and wanted to know more. So we've got a little bit more information today. We're zooming in specifically to one of the KPIs that impacts consult to treatment. And that is IVF conversion rate, the percentage of patients that move on to IVF conversion, and part of the reason why that move on to IVF, that is and part of the reason why we've zoomed in on this so much in the last.

Two years or so is because of a phenomenon that we noticed as people are getting busier. And I'm calling it Griff's law for now because, oh, it's like, I noticed that and I wanted to name it something, and I wanted to name something Griff's law. When I figure something out that's cooler than that.

It's not going to be called that anymore Steph. But for the moment, what is Griff's law? 

Stephanie Linder: [00:02:57] Essentially with a large new patient increase we see IVF conversion rate decrease. 

Griffin Jones: [00:03:02] IVF conversion rate decreases with large new patient increases. And lots of people are seeing that right now. So even though people are seeing IVF go up as well, because they're seeing so many new patients come in.

Many IVF centers. Aren't even noticing that their conversion rate is actually going down. So if you are among the cohort that is seeing lots of new patients right now, this might be the episode for you, especially, because as we zoom into IVF conversion rate, There are six different points of the fertility patient marketing journey that affect IVF conversion rate.

And when we were doing this Steph, I really struggled because I wanted to present it in the clearest way possible. So I thought of maybe. Ordering these in chronological order because some of them precede the patient even coming into the office. But ultimately we decided that we wanted to present it in order of importance.

So in order of importance, what are the six major things that impact IVF conversion rate? 

Stephanie Linder: [00:04:09] So it all starts with how the physician presents the info, the physician presentation. The second most important is how you're following up after the consult. So really the post consult follow-up, the third is educating your patients about how they pay for treatment and how they finance it.

And the Options available to them after that, it's all about how do you educate the patient before they walk in the door? So that's number four, your pre-education content number five. It's. How do you share it with them prior to coming into the consult? So we call that the welcome sequence. And then number six, is your patient support, how do you offer ancillary services or tell your patients about those services that support them through the fertility treatment journey?

Griffin Jones: [00:04:52] So we're going to get into these six in greater detail. I think there's a few profiles of fertility center that shouldn't invest in an IVF conversion strategy. That's folks that have just started up. If you're a brand new center focused on getting new patients, if you're super high growth, focus on getting new patients.

And if you were one of the centers that. Was doing really well for awhile. And then you got a little bit older and some younger competition moved in and you didn't invest a lot in business development. Then you started to decrease new patients, go back to focusing on new patients. But I'd say there's probably at least three profiles of fertility center that should invest in IVF conversion-rate strategy.

First, who are they? 

Stephanie Linder: [00:05:34] Yeah, that's a really good question. So it's the people that are maxed out with your new patients but are still short on their IVF retrieval goals and retrieval capacity at their lab. The second would be folks that have never actually done marketing or business development in the past.

Griffin Jones: [00:05:51] So those folks sometimes talk about for this type of strategy, just because if you've never invested in marketing before, if you were one of these centers that was spending half a percent of gross revenue on business development, it's from a different. Era and to get you into the era where you're competing with wall street, back clinics or Silicon valley backed ventures, going right into a marketing or business development program for many might just seem alien.

So why is it that we recommend an IVF conversion rate strategy for them some of the time? 

Stephanie Linder: [00:06:24] Really, because of it's the ROI you can see on it. If you start this early, And in the right cadence, you can actually pay yourself back within three months of inception of starting the conversion rate program.

Griffin Jones: [00:06:36] Okay. So folks that are already maxed with new patients, but short of IVF capacity, that's a, no-brainer those that have not invested much in marketing or biz dev, because the ROI can be a lot quicker. It's a lot closer to the sale. And then third who's that? 

Stephanie Linder: [00:06:54] The people that are ready to sell the equity in their practice. But we put a timeline on it usually within one year. 

Griffin Jones: [00:07:00] Because if you're going to sell further out in the future, then it's really about adding value to your brand, to your group before you sell. But if you're going to sell within less than a year, then what, you're not going to do a rebrand there's maybe not a lot you would do in other parts because it would take too long to see the return, but less than a year, we're comparing it more to like an apartment complex, like an income real estate venture. And what's the analogy there Steph 

Stephanie Linder: [00:07:34] Yeah, actually, when we talked about this before, I thought it was a really good analogy. So if you have a hundred unit apartment complex, even just increasing the rent by about $50 a month, the financial benefit, isn't just that $5,000 in monthly, additional revenue.

It's talking about increasing the total value of the property when you go to sell it. And your practice is very similar. When you talk about. Increasing that conversion to treatment percentage. 

Griffin Jones: [00:07:59] In our field, we always use the EBITDA We don't use capitalization rate that is for real estate, but I agree that's a really good analogy to use because if I just get this conversion rate up and we are a machine that converts more people to treatment, even if I'm just showing a six-month bump, that's a lot better than being flat or certainly decreasing and it can help in the sale. We've had people on the show talk about different. Perspectives on that. I promise you it's always better to add value. And that's one where you can do it more quickly and it's a lot more closer to sale. So, okay. So we've got the three folks that we'll probably want to focus on IVF conversion rate.

We got the six things that impact it. Now I want to. Just do our disclaimer that we always do whenever we talk about IVF conversion, Stephanie, which is we're not clinicians. We're not saying that every person should move to IVF. We're also not wall street people. We don't own equity in any fertility center.

We're not trying to get a certain value back. We don't get a commission on that. We're just trying to help people reach their goals. So we know that a hundred percent is never going to be the number. We just want to make sure that people aren't. That aren't moving on to treatment. It's not because we weren't clear or we weren't helpful.

Right. I think that's a good disclaimer. So we've ranked physician presentation at the top of our six things that impact IVF conversion rate. Why and what is it? 

Stephanie Linder: [00:09:37] So really it's I would say it's the greatest variable in the conversion to treatment as being the provider. So there is just this innate nature that some physicians have that makes them just a little bit better at moving some patients along to treatment than others.

So we can't tell you exactly how to do your job, but what we really can say and encourage is that be strong in your convictions and what you share with patients as the best. Next step patients come to you for advice. You're the expert and being strong in that makes a huge difference in how quickly and who, how many patients actually convert to treatment.

Griffin Jones: [00:10:10] I wasn't totally ready to put physician presentation as the most important, but then something changed my mind. You know what? It was you and the other Fertility Bridge people. After we have a doctor that is really. Clear and just really present, let's say you and the other Fertility Bridge people will say, I wish she was my doctor.

I wish she was my doctor.  I could see 

Stephanie Linder: [00:10:36] I know you're thinking right now, as we're talking, I know exactly what you mean. 

Griffin Jones: [00:10:40] The most recent example, but sure enough though, you look at that doctor's numbers versus another doctor they're different. 

Stephanie Linder: [00:10:48] Yeah. And it's not even about being overly aggressive with it.

I think some people assume that but it's really, they're still often a compassion kindness, but they're just so confident in this is what you should do that you buy in and you just want them to be your physician and you trust them with everything you have. And it's really hard to teach. 

Griffin Jones: [00:11:06] I've only known maybe one or two that were really aggressive and their conversion rate was not.

Good. The folks whose conversion rate is really good is the folks that are just super clear. They don't give the patient a lot to be paralyzed by analysis. And again, this is where a physician could say, Griffin, Stephanie, you're not doctors. You don't know what it's like. And fair enough. If you have a counterpoint, you're perfectly welcome to come on the show and talk about your counterpoint.

I'm not saying that you, one person needs to present a certain way, right? We're just sharing with you, the pattern of people that are really good at converting to treatment. And we've learned a lot from them. So when we used to do our goal diagnostic, for example, used to leave the strategy a lot more open-ended until we actually went in and did the blueprint.

And now it's like, well, we know it's one of six, eight problems. So we're diagnosing that in the goal diagnostic. And then we're saying, it's this blueprint you need. And since we've been doing it that way, people just find it a lot. More clear. We're still being as helpful and genuine as we were before, but in our goal to not push people into something that they didn't, that they might not have been ready for, or we left it way too open-ended and now having taken Page out of these doctors book, we're helping people a lot faster. There's no pushing. It's just saying, okay, you don't have to do it with us, but this is the strategy that you need. And we see the same thing happening with these docs that are just giving the patients a lot easier of a path to begin in their mind. 

Stephanie Linder: [00:12:47] Yep. Just a lot less for the patients to think about too. 

Griffin Jones: [00:12:51] Okay. So we've had the patient come in, again, we're not going in chronological order. We are going in order of importance, but we've got physician presentation as the most important what's next. 

Stephanie Linder: [00:13:04] The second most important is the post consult follow-up.

And so when this is done in a, in the right systemized way after the initial consultation, it's one of the quickest ways to convert more patients to IVF cycles. 

Griffin Jones: [00:13:19] And so this is to address something. This is a term you came up with. So I came up with Griff's law. We haven't called this Stephanie's phenomenon yet, but what do you call this phenomena?

Stephanie Linder: [00:13:29] Yeah, I'm waiting for something a little bit cooler today, to name myself, but I named this the post consult black hole, which is patients come into the console, they seem excited and ready for treatment. And then you essentially just, they get a few tests done or you really just don't hear from them again after consult.

And you don't really know why. 

Griffin Jones: [00:13:49] And that console can be the initial concept or it could be the follow up visit. We do recommend follow-up visits but were not going to get into that today. We're going to talk about the follow-up after the initial consult or the follow-up visit, which wherever the drop-off was, because that follow-up does three things.

Stephanie Linder: [00:14:09] Yeah. So it's really supporting patients in their journey. It's assuring and giving them the confidence that you are the best choice for them and their fertility care, especially in a world where there's lots of options for different fertility clinics and three it's queuing the decision it's giving them a final reminder that, Hey, I need to make a decision and I need to do this quickly. 

Griffin Jones: [00:14:30] None of those things is push. None of those things is force. You follow up with people, you are supporting them. There's so much uncertainty and you're assuring them. And when you're queuing the decision, that's not forcing them to make the decision. You can't force anybody to make a decision.

They've got a number of decisions going on in their lives. It just cues the decision. Meaning. This person brings it up with their partner again, as opposed to just letting it go off into the ether forever. And if I can go on a little rant Steph now that I'm of this age and have been in the field for the seven years that I've been here, people.

Talk to me, not people in the field friends, and they tell me things like, yeah well, we're thinking about it well, we went for a consult and, you know, we're just kind of still mulling it over. Meanwhile, they want a child in the worst way, and now they're in their mid-thirties, late thirties. They keep pushing it off and they are putting themselves in a worse position, it is doing someone, a service to cue the decision. If you do it the right way. And another sidewall we're here is when Stephanie and I say the patient in most cases unless we say otherwise, when we're talking in this third phase of the patient journey, we're talking about the patient and their partner.

So there's two times. To follow up that are really critical. What are they? 

Stephanie Linder: [00:16:02] You want to follow up 30 days after the last consult that you had with a patient or the last touch point that you had with the patient. And this is really crucial because more than likely, unless there's someone that, you know, doesn't ovulate regularly or another clinical reason by this time, the patient's likely had the first day of their period.

So if they haven't called you, like they were supposed to let you know and move forward with the next step. There's likely some reason or some kind of barrier that's preventing them from moving forward with treatment.

 So 30 days is the first touch point, but the second touchpoint is 60 days.

So essentially those same people that perhaps you didn't hear from after 30 days, you want to check back in 60 days, you would just want at least two touch points. And you know, a lot of people think, okay, is this too salesy? Is this they think about it as negative because healthcare providers aren't always necessarily.

Used to marketing. And what we've seen is actually exactly the opposite. And I love sharing the story because it is just so positive. We had a client that actually followed up with their patient twice do the 30 day and 60 day. And when they did get ahold of them at the 60 day followup, the patient actually got pregnant naturally.

And so that's the reason they didn't contact them again, but turns out the patient was technically pregnant at one of the early appointments or when they made the first appointment I had named or decided to name their child after the physician, the middle name at least. And so the patient was super appreciative and loved the kind of support and care the clinic offered, even though they weren't moving forward with them. And that kind of, you know, word of mouth or the reputation that starts to build in the community is just unparalleled. Like there's no marketing that can really do what that phone call just did.

And I just want to share that example, because that is really like the worst case that we've seen come out of these kinds of followups. Which is really an amazing best case. 

Griffin Jones: [00:18:01] That's one, it's very useful touch point on behalf of the center to do, because it shows that they care. It's also great feedback to get.

You don't get that feedback if you don't do it. So we have a pecking order of who should be doing the. Follow up in a perfect world. And that's why there's a hierarchy, because if you can't do it at the top, in the perfect world, then you move on to the next one. So how does that hierarchy flow? Of who should be doing a follow up. 

 

So we have a pecking order of who should be doing the. Follow up in a perfect world. And that's why there's a hierarchy, because if you can't do it at the top, in the perfect world, then you move on to the next one. So how does that hierarchy flow? Of who should be doing a follow up.

Stephanie Linder: [00:20:25] Yeah, of course. 

So the first the physician always should be in a perfect world doing the follow-up. Your patients chose you as their physician, or at least for the initial consult they want to hear from you. And it means a lot if the physician is calling, of course, that can't always happen. So the second Second point in the hierarchy would be any kind of advanced provider, your NPs, your PAs, the third would be a nurse.

And then after that would be MA medical assistant, and then last but not least would be your front desk staff or any of your staff that has the capability to answer at least some basic questions, but not get too clinical. 

Griffin Jones: [00:21:02] So somebody is listening to this and they're like, okay, so what you're saying is front desk staff, they're skipping right over the other, or maybe an MA. If one of your clinical staff can't do it, that's fine. That's why we have the hierarchy. It is dramatically better than nothing. Perhaps the only profile. Of center that does even have the time to do this are those that were doing really well for a while. And aren't, and then if that is the case, use your physicians to that advantage.

But even if it's somebody on the front desk, if it's a new patient navigator, if it's a MA, then that's much better than not following up with...

Stephanie Linder: [00:21:44] I'd also add though, it's also an amazing opportunity for your recently graduated fellows or physicians that are moving to new geography to build up their practice and their name while they have a little bit more time in the beginning.

This could be a great way to build that practice. 

Griffin Jones: [00:21:59] So this is useful for everyone but it's especially useful for those physicians that aren't as. Good at converting people to treatment. Again, we're not here to say with what physicians should be doing, what we're just saying that if you are one of the physicians, that's a little bit less direct.

One thing I do recommend, Stephanie, is that the physicians take the big five personality tests. Sometimes that's called canoe. Sometimes it's called ocean. See where you are on agreeableness. People that are real high on agreeableness might have a harder time being as direct because they want the patient to feel like they have options.

People who are lower on agreeableness might need to do some sort of empathic training. And Dr. Ali Domar talks about that. But if you're real high, you can run into the other problem, which is not being as direct. And if that's the case for you, this type of. Follow up. And the other things that we're going to talk about are even more important.

So we've got physician presentation, we've got follow up. Then what about finance and payment? What's that like? 

Stephanie Linder: [00:23:02] It's all about the money. We found that this obstacle is really not just about patients not being able to afford it while that's true. That's just a small percentage of this it's patients just don't know if they should spend their 20,000 on IVF or just a few thousand on IUI and which way to go it's how do they afford it?

What kind of programs do they use and how can they maximize their different benefits? Mainly through insurance to make sure as much as covered as possible.

Griffin Jones: [00:23:30] So when we say it's a small percentage, what we mean is that Dr. Domar has research that shows 42% of patients say that cost is the highest barrier that's in line with what we've seen.

And. That in and of itself is just one thing it's it does not necessarily mean that the patient has no way of being able to pay for it. So you break what the practice needs to do to help people find out what they need to do to pay for it. How they can be able to afford it into staff and materials. What role does staff play in financial education?

Stephanie Linder: [00:24:09] Yeah. So I mean, your staff, essentially, the person that answers the phones, your front desk and all your financial counselors are essentially the first line of defense and helping your patients with this understanding the finance and human dilemma. So you want to make sure that training all of your staff, those key the frontline of defense, essentially.

Make sure they are trained with specific scripts and specific cadence on how to answer questions about pricing insurance. Do they know how to explain the difference between in-network and out of network? That's one of the biggest ones that we hear that people cannot properly explain the common pain for treatment questions.

And so they need to know the script, what to say, the tone, how they actually say it, and then the cadence and the order. And when they say it.

Griffin Jones: [00:24:56] Okay. So you've got a well-trained staff then what do they need to have both when they meet with patients to be able to give them afterward and for patients to be able to see, even before they come through.

Stephanie Linder: [00:25:11] So they should be giving them in the meeting is really easy to understand financial materials that decode essentially some of the common acronyms way too often. We see these price lists that have about 10 or more acronyms with, you know, line item and patients just don't understand why ICSI is separated from everything else.

So really making sure those materials are as easy and straightforward as possible will really help with your conversion rate. But also sending certain items and some what we call like pre-education sending certain materials ahead of time will really help.

Essentially pre-sway the patient, which we'll be getting into a little bit later as well, but you want to be making sure to send videos where they get to know your counselors, get to know your staff, get to know how to pay for treatment ahead of time. So they're not surprised when they come into the initial console and have that conversation for the first time.

 Griffin Jones: [00:26:03] And this is where good creative comes into play. So if you're looking at the fertility patient marketing journey, every single segment on all four journeys is an opportunity for a good creative. You don't need to do materials the same way that you've always done them.

The same way that everyone else is doing. That's where good creative comes in to make it something that people actually. One want to read and to understand, and that's our segue into pre-education content. This is one of the six areas that really impact IVF conversion rate. It is an umbrella term. And when we made these six, we did over overlap. Some of them, you could say that the welcome sequence is the activation of the pre-education content or that financial materials go into pre-education. Pre-Suasion they do, but pre-education  is a good way of thinking of all of the content that you use, no matter how it's distributed that.

Gets patients to have a baseline of understanding and rapport before they ever come in. That's what we want to do with pre education. We don't want the patient to be a deer in headlights. When they're talking with you, we want to give them the information they need to know when they need to know it. And so they have an idea of what's going to come next.

So they receive information more readily. They feel more comfortable with you, and they're less likely to have. Barriers that shouldn't be there when they are ready to move forward to treatment. This is where you can really get creative and we've done so much content on content that we're not going to do it today.

Getting into this pre-education Pre-Suasion more deeply, but. Pre educating patients before they come into the door is really essential, not just at the finance and payments stage, but for the entire IVF conversion goal. Now we're talking about one way of delivering it and that's the welcome sequence.

Talk to us about that. 

Stephanie Linder: [00:28:03] So essentially the welcome sequence is what happens before the patient gets into the initial consult. What are you sending them? How are you making sure that they are pre-educated and essentially are looking forward to treatment? And so what we usually see in a welcome sequence now is just, Hey, here's how to set up your portal.

And here's a form to fill out your medical history and get records from your OB, but it needs to be so much more than that. And so there's a variety of ways you can send the welcome messages, but they have to include. Four key components. The one is a sincere welcome from the physician, which is sending expectations and then preparing a patient who wants to come.

And it's crucial that this is from their specific physician. The second is a lot of the components of what we talked about around finance and payment. Pre-education really just making sure the patient understands how they're going to be able to pay for treatment and what their options are.

The third would be a patient testimonial, so it's a way the patient can see themselves and others feel that the clinic and the other patients are relatable and really a way to encourage the patient when this is a time that they may be getting cold feet. Cause this is one you're going to be sending a little bit closer to the initial consult and the last, but not least number four would be just a simple reminder of the upcoming appointment and a confirmation, but still know, let the patient know that you guys are thrilled and prepared and ready to see this patient very soon.

Griffin Jones: [00:29:33] A good welcome sequence really helps with cancellation rates too, because you're nurturing them in this way before they come in, getting them excited. This waging their concerns and dissuasion concerns is the name of the game. When it comes to our six area for positively increasing IVF conversion rate that's patient support.

Before I turn it back over Steph, , I want to talk about why this is included in IVF conversion. Because when I first entered the field, I would notice people leaving negative reviews, or if they had something bad to say about the client, I did the clinic, I did some. Research of looking at positive and negative reviews and it really does matter.

Someone is much more likely to leave a negative review if they didn't have a positive outcome, we'll go figure, well, I want to unpack that some more partly because. When they see baby, baby, and miracle, and we've got the best success rates and people don't always say it that way, but sometimes they also, don't not say it that way.

And prospective patients can fill in the blanks with their mind. Then they have a really high expectation. And that only expectation is one. Clinical outcome. It's one healthy baby at the end. And I know we've gotten really good with success rates, Stephanie, but there's still not a hundred percent and they're still, it's still really high for somebody who's spending tens of thousands of dollars of their own money.

Who's putting so much of their emotional. Focus and energy into the process. And so if the only outcome that we can give them is a clinical outcome that we really can't guarantee. Then we're often setting ourselves up for failure. And so we want to at least be giving. Prospective patient, the new patient as much value as we can outside of the clinical outcome so that there are other things to delight them with.

And then I saw some research from Dr. Ali Domar that shows that post consult only 32% of respondents that are not seeking treatment reported that their healthcare professional offered supportive services as compared to 61%. Of respondents that were seeking treatment. So we see more patients continuing with treatment when they've been recommended support.

And that comes in three different categories, which are? 

Stephanie Linder: [00:32:07] So you have your support groups. These are your resolves, whether they're a national or your local more independent support groups. Number two is your mental health professionals, psychiatrists, psychologists. And then the third is a, an umbrella term as well, but it's more wellness support.

So that's including a variety of different things, but I would say the three most important are your nutritionist. Your acupuncturist and some, a little bit of information about exercise. 

Griffin Jones: [00:32:39] And when you have those networks to be able to refer to and those professionals to whom you can prefer, how do you let the patient know about them?

Stephanie Linder: [00:32:50] So, it's definitely possible that you can put some of those sources on your website. Especially I think in the exercise or more just general information about maybe eating or yoga or anything like that. But I, with more of your wellness professionals or mental health professionals, there may be so many people that you refer to or trust that it.

Just as it makes sense to put everyone on your website. So it's always helpful to have an internal document that you can post in your patient portal, email it to the patients as requested. So you kind of have a go-to resources that can say, Hey, if you ask a question about this is where you go. And that will also help build often some of your referral patterns because clinics actually on average, see about five to 10% of their referrals come from the three things we just mentioned. So the overall wellness community.

Griffin Jones: [00:33:40] This is an area where you and I don't totally agree about putting all of the potential refers on the website on material. Let's hash it out right here for the Inside Reproductive Health audience.

Why not? 

Stephanie Linder: [00:33:55] So from my opinion, especially when I see in our clients and bigger markets take a New York, Chicago, San Francisco. When you have, let's say acupuncturists, where there's 20, 30 people that are in your referral network and just putting three or four could actually be more harm than good and show bias.

I think it makes sense to keep some of that stuff more internal because the second someone sees that they're not up on your website, they might get pretty pissed at you. 

Griffin Jones: [00:34:21] Well, so there's two points to that one. Why not put all 20 or 30? 

Stephanie Linder: [00:34:26] I think it's too overwhelming. 

Griffin Jones: [00:34:28] I don't. I think maybe you do, you direct to a couple that are, if you're in person with somebody, but my philosophy on a, B to C content, which is essentially what you're doing here in a B2B strategy, or maybe that's flipped is feature everybody. And then your second point was it, well, it rubbed somebody the wrong way. If they're not on there. I think it's a great problem to have. If you forgot somebody and somebody said, well, why wasn't I on there?

It's like, we would love to have you on there. And then that's a social media strategy, right there giving every single one of those people love over time. And if somebody says, well, why didn't you do a feature on us? We would love to Brian, when can we set something up? 

Stephanie Linder: [00:35:16] Well, there's a lot of points to make, to counter that.

I think to have your patient go through 40 different acupuncturists and call each one is not something they're gonna do. So then a you start having people argue with you about who's up top or who's placed first on the list because they're more likely to get called. It's just something that really can snowball.

So I believe it shouldn't be more internal on certain things and you post it in the portal. Your nurses can just refer to it. You that's really about it.

Griffin Jones: [00:35:44] I know that most of the clients and most of the listeners are going to agree with you because they don't want to deal with that. Some people are going to see that.

Yeah. I think that's a great problem to have. So you've just heard it right. That you've just heard the pros and cons you decide with how you distribute your patient support information. So in summary, there's four key performance indicators that drive IVF volume IVF conversion rate is just one of them.

That's what we talked about today. The things that impact IVF conversion, the most are physician presentation, post consult, follow up finance and payment. Pre-Suasion pre-education welcome sequence and patient support. There's a few different profiles for whom that's the best strategy to go to first, if you would like.

Our help in deciding if that's for you of what's missing from yours. If you're not converting as many people, we do that in the goal diagnostic it's cheap. It's easy. You get. To meet with Stephanie and I for two different meetings. And we get to talk about this. We can spend the whole time talking about IVF conversion rate.

If you want sign up for the goal diagnostic FertilityBridge.com. Stephanie, thanks for unpacking this with me and look forward to having you back on to go into some of these in even greater detail. Yeah. I look forward to more debates come prepared. I'll try. Thanks Steph. Bye 

Breaking Through the REI Bottleneck with APPs

Tamara Tobias on Inside Reproductive Health.png

Sometimes it’s the REI that holds back the growth of a clinic because he/she is doing tasks that could be delegated. It’s our job at Fertility Bridge to help you bring new patients through the doors of the clinic and it’s your job to convert as many of those patients to treatment as needed. In this week’s episode of Inside Reproductive Health, Griffin chats with Tamara Tobias on her perspective on the role the APP plays in reducing the REI bottleneck.  

Tamara Tobias is a nurse practitioner supervisor at Seattle Reproductive Medicine with over 24 years of experience. She is active in ASRM, currently serving on the Membership Committee. She helped develop the REI nurse certificate and basic courses available through ASRM and is a recipient of the ASRM Service Milestone Award. She is also an active leader in her local fertility community and publisher of Fertility Walk

Topics covered in this episode include: 

  • What your APPs should be doing vs the REI

  • How the REI could increase productivity by only doing follow-up appointments

  • What to do to have recruiting advantages

  • Training APPs 

Connect with Tamara: 

LinkedIn: https://www.linkedin.com/in/tamara-tobias-0752bb30/

To learn more about our Goal and Competitive Diagnostic, visit us at FertilityBridge.com


Transcript

Griffin Jones: [00:01:01]  Breaking through the REI bottleneck with advanced providers. That's the topic that we're going to delve into on today's Inside Reproductive Health. To help me with that. I've got Tamara Tobias. You might know Tamara because she's a nurse practitioner supervisor at Seattle reproductive medicine over 24 years of experience.

And she's been very active in ASRM before I get into today's show. Today's shout-out goes to the NPG, the nurse professional group, the subgroup within ASRM, who does a lot of good programming. That I think is relevant to today's topic. And because of that, I wanted to give them a shout-out. In today's episode with Tamara, we talk about the role of the physician extender or advanced practice provider.

If you're hip to the current nomenclature, how that started off their role, maybe 15, 20 years ago, how it's changed radically in the last five years, but really in the last year and how they are part of the key to us, being able to see more new patients as a field, move more people to treatment that need it, and aren't stuck in the REI bottleneck.

And so we walk that line together. What those APPs should be doing and what really needs to be in the purview of the REI because that's a sub-specialty for a reason And so Tamara gives you a lot of food for thought In this episode if as a clinician you have a different point of view You're welcome to come on the show I'll tell you every time that I do a show that butts up with something that's clinical operations My job is to get as many people to treatment as needed And I could keep bringing new patients to clinics all over North America But to the extent that we hit this bottleneck there's gotta be other solutions which is why I'm interested in unpacking solutions like these if you have a different point of view, you're welcome on the show. If not sit back and listen to the point of view that Tamara gives us today. Ms. Tobias Tamara welcome to Inside Reproductive Health. 

Tamara Tobias: [00:03:01] Thank you. Thank you, Griffin, for having me excited to be here. 

Griffin Jones: [00:03:04] I'm excited to have you, because I'm looking forward to going down a topic that I think is inevitable.

We were both talking about how some clinics have been so busy recently. And so I think the role of the physician extender or advanced provider, whichever nomenclature people use in their clinic is going to be getting more and more involved in the coming years. And you being a nurse practitioner that's been in this field for a while.

I would love to hear your perspective of just the role of the nurse practitioner. And if you can speak to it also, the physician assistant was when you started and then how it has changed. If that is in fact, the case. 

Tamara Tobias: [00:03:47] Yes, I'd be happy to. So when I started, back in 2004, they really weren't sure what to do with the nurse practitioner.

And so I was actually hired on as the third party, program coordinator to just bring up the third party. I think that's how a lot of nurse practitioners started as people thought, okay, can you develop our third-party programs? And really it has evolved. So much in these last years where we're really utilizing the nurse practitioners skills to its full extent.

And so now by doing procedures and ultrasounds and seeing patients, and really I'm speaking of nurse practitioners and physician assistants, and I think the best term to utilize, which is more, the term everybody's using across the country now is. APP, which is advanced practice providers. So that includes your physician assistants, your nurse practitioners, and your nurse midwives,  in reproductive medicine there right now that the trend, there are more nurse practitioners than PAs.

We did a survey with the nurses professional group. About two years ago. And with that, we had about 30 respondents and there were 23 nurse practitioners at that time and about six PAs and one nurse midwife.  But I see those numbers definitely growing. 

Griffin Jones: [00:05:07] It seems to be the case that nurse practitioners outnumber PAs, at least from just our clients and people that we work with.

So it started off with a third party role and you still see, I see a lot of NPs in that role, in fact some clinics that are bringing on NPS for the first time. I still having them do that first. That's like the first thing that there doing. So how did it grow after that then what happened? 

Tamara Tobias: [00:05:31] You have to push, they have to push. Is there a way to show them that they can do? And,  that was me being a little bug in their ear is like, I, yes, I can see these donors and bring on the third party, but I can see your recipients and I can do their ultrasounds and I can do that donor ultrasounds. And then they can see that if you're performing those well and you're doing a good job at ultrasounds that it opens up to more like, oh, sure Maybe you could do more ultrasounds follicular dynamics. And then it even evolves to doing OB scans and then it becomes procedures. I think if you're working third party, they think, well, maybe you're doing ultrasounds. Now you can do a sailing on a histogram, maybe on my recipient will you do that salient sonar histogram was using an ultrasound, but then you could push a little bit more and say, well, I can do not only recipients. I could do your regular IVF patients. And now I can do office hysteroscopy and HSGs and hysterosalpingogram. And so you just, it's just keep raising the bar because you are practicing within your scope.

And we'll talk a little bit more about scope and different states, but I think it's just letting those physicians realize , The training and the background that you have and how you can apply those skills. 

Griffin Jones: [00:06:46] So let's talk a little bit about that scope. How do we know that a nurse practitioner or a physician assistant is qualified to do those things that you said?

Tamara Tobias: [00:06:56] Yes. So if you look at our training, if you look at federal law, simply states that nurse practitioner needs to follow the training and the education based on your state. And that's where it gets tricky because every state has a different scope of practice. And for example, in Washington, we have a very broad scope of practice.

So in Washington we've really, I really can provide care to my full education. So that's diagnosis, that's management, prescribing, and prescribing medications. That's all within the scope of practice. That's Washington state. Now you have other states, for example Michigan, unfortunately, nurse practitioners there they have to operate under their registered nursing license and the only way they can apply for their skills such as, procedures or ultrasounds under supervision of a physician. But I think having said that, I think in reproductive medicine, we're so specialized that even if we're working in a restricted state and every state is so different, even if we're working in a restricted state, I think in reproductive medicine almost all of us nurse practitioners, or APPs, we are working at collaborating with the physician. And so if we're collaborating with a physician, then we should be able to apply all of those skills and be able to provide all of those services. 

Griffin Jones: [00:08:20] So it really really depends on the state medical board. That's who sets the scope for the APPs?

Tamara Tobias: [00:08:26] It's the state it's both the state medical board and the board, the nursing board of that state and its legislation in that state. 

So you're in Washington state and maybe you can't speak to Canada. It's okay. If you don't have any cursory knowledge of that, but we have some Canadian listeners. Do you know any, anything about the regulations in Canada with regard to APPs?

Not a lot. I do know there was an APP in Canada. She's fantastic. She's reached out to me. I'm just reaching out to find out what I do in my practice and such to see if she can start doing those things in , her office. And so I'm always happy to share. I shared with her, my orientation checklist that I have of every heck includes all of not only procedures, but as well as consults that we do.

And I shared that with her to see if she can start doing that in Canada. 

Griffin Jones: [00:09:19] If we have any Canadian APPs that are listening and they know a little bit about the legislation and the regulations in different provinces. Feel free to email me. We'll have you on the show. We'll do an entire episode about APPs in Canada.

One thing you mentioned infertilityTamara was procedures and talk a little bit about that are we talking IUI, what else are we talking about when you say that APPs? 

Tamara Tobias: [00:09:42] Yeah, Procedures, so ultrasounds and ultrasounds can be ultrasound for follicle, your IVF, as well as OB scans IUI, and the  endometrial biopsies uterine evaluations and the most of the uterine valuations I do our office hysteroscopies,  but we also provide HSGs as well as SIS is the salients on a histogram.  We do biopsies for ERA when we're looking at that and our mutual scratches, which is outdated now, but we can do that a lot of physical exams on all your third parties.

And then I would say the other thing I do a lot is problem visits. So those that are calling in, they have pelvic pain or they have cyst or they're bleeding, somebody that needs to be seen same day. And so that's a lot of  what a day-to-day is. 

Griffin Jones: [00:10:30] I want to come back to the problem visits, because that ties into another sub topic that I want to address with you.

 One of the things that's involved with procedures that I hear people talk about is retrievals for IVF. Can an advanced provider do that? 

Tamara Tobias: [00:10:44] That is a surgery. And so advanced provider, I do not know of any in the United States that would do that. Not necessarily in our scope because it is a surgical procedure.

So again, within the scope of our nursing background, our focus was really,  wellness and education. We can diagnose and treat and do some procedures, but not necessarily a surgical procedure. Now I can't speak on that with a physician assistant. Because they may there's physician assistants who do some surgical procedures or assisting.

And so that could be a possibility. 

Griffin Jones: [00:11:21] Okay. That's an interesting distinction. Let's go back to the problem. Patients. Everybody loves the problem patients and it seems like, oh great. I'm an advanced provider. I'm the one that gets to deal with these problem calls a problem visits and what I'm wondering is how does it tie into one thing that physicians really concerned about, which is what does the physician need to do?

[00:11:48] What does the physician really need to be present for? And some would say, well, absolutely. The high-touch cases are the ones that the REI absolutely needs to be involved with. So. What's the  purview with problem visits. When there's a NP, that's perfectly qualified to take care of at least some of them, 

Tamara Tobias: I think we're all working together.

And so when they, when these patients come in with problems that it could be hyperstimulation, I don't see as much as that anymore. I used to, unfortunately. So it'd be hyperstimulation it may be an ectopic pregnancy. I just had a molar pregnancy. So I think the key point is. The physician or they are may be in a zoom consult.

Right. And their schedule is packed and I might have a 15 minute opening in my schedule. So those patients come on, I'm doing that initial assessment. I'm doing that screening. I'm doing some blood work. I'm seeing what's happening. I'm doing the ultrasound, but I'm then collaborating with the physician. So I think it's important. For all APPs and we all do this. We work very collaboratively with our physician and follow up appropriately. So depending on what I see, I may have to pull that physician in. Maybe during that consult and get in another opinion, or if I have a field demise, I might not. I want another set of eyes. I may say I'm so sorry.

I don't see a heartbeat, but I, that is such an emotionally charged moment that I definitely want to pull somebody in and just get another set of eyes. And so I'll do that. And so I, that's why I feel that even those problems, they're hard. They're very difficult. Cause they're just added on your schedule. But you're not out there flying solo. You're definitely collaborating. 

Griffin Jones: [00:13:28] Collaborating, but is the collaboration triaged is the app essentially doing triage on these problems visits and then bringing the they're the gatekeeper that brings the REI in when there's the most complicated cases. 

Tamara Tobias: [00:13:40] Yeah. Yeah. Unless we can manage it.  But I would definitely consult, like, if I feel like this is what it is, if it is an ectopic pregnancy, I'm not going to be the one doing the surgery on that ectopic pregnancy. So I think it's important.  To absolutely bring them in. 

Griffin Jones: [00:13:56] Well, I'm thinking from the REI, point of view, should they be having, if they can have the ability to hire APPs, should they be having APPs do the problem visits to triage those cases?

And then the REI comes in on those cases that the advanced provider brings them into. 

Tamara Tobias: [00:14:15] Sure. I do think  that the problem visits are going to be the most challenging. And so those are, you're going to want your more experienced APP to be managing. So it may not be until a couple of years down the road where that physician feels very comfortable knowing that APP is more experienced and better able to triage co-manage those patients.

I think the day to day, things like that procedures the routine ultrasounds. Absolutely. We can do those, but I think it does come down until more training and more, more senior.

Griffin Jones: [00:14:54] Well, let's talk about that training and how one gets to that level of seniority, because the entire reason why you and I are talking about this topic Tamara, why is a marketer so fricking interested in nursing operations here?

It's because my job is to get a million people through IVF treatment in the United States that needed versus the 200, 250,000 that are getting it right now. The bottleneck right now is the clinic. The bottleneck is the clinic, the lab, the doctor, and I could bring people. Way more patients, but we're still hitting a wall.

And so anything that starts to get more access that we can treat more patients with. That's what I need to learn about. So you mentioned that. That level of triage and seniority comes after a couple of years, what training needs to happen in order for them to get that senior level of experience?

Tamara Tobias: [00:15:47] Yes 

you're absolutely right when we both talk about marketing because I think about that and, bulk of revenue is from IVF, right? For reproductive practices. It's the IVF, it's the surgery. And that does need to be managed by the RE. But utilizing a nurse practitioner or an APP, I think is a win-win.

If you utilize them for procedures, you're utilizing that for procedures, for ultrasound, that's going to free up your REs time. And so that RE can be doing more of the IVF consults and then your advanced practice providers can be doing more of the procedures and the ultrasounds. And even with the ultrasounds, I think the benefit there is that the APP.

As a nurse practitioner can be helping talking about their plan. We can talk about their next steps can diagnose if they, perhaps they have a yeast infection and it saves nursing calls because they don't have that. The nurses don't have to do as many callbacks if the APP sees that patient.  So training can be tricking. It depends on their background. So it really depends if I have a new nurse practitioner who first was an RE fertility nurse. And I have a lot of those actually in our practice had five of them that were fertility nurses first. And then they went on to go to school to get their master's degree in a nurse practitioner.

So they have a lot of that RE experience. They're not going to take us long to train. But it is. It's not as straightforward and there's not an organized program out there. And I do my best. I developed a program in our practices because of the number of APPs we have, but I think it's important to look at ASRM as a resource, an excellent resource utilizing the ASRM certificate course.

I have them do a lot of independent study, a lot of independent study reading F & S for fertility sterility. If it's a nurse practitioner in a small practice where it's just one doc, if there's going to be a lot of one-on-one training and observing and learning those procedures. And until that physician feels comfortable, APP can do those on her own or he or she on their own so it's time.  

Griffin Jones: [00:17:55] If you could build your master course, if you could create it beyond the, and you've done a lot with your own practicing, I think we've also done work with , NPG and other groups. If you could create this master course, what would the table of contents be for to bring other advanced providers up to the level that REI will feel comfortable turning the reins over to them? 

Tamara Tobias: [00:18:18] So one is the basic understanding. So you're going to have a huge didactic component going through all the components of infertility and then the second is going to be procedure. And I think there's a lot of really good online tools now. For example, ultrasound, how do you train somebody to do an ultrasound?

And there's a lot of good there's even YouTube videos. And I have a list of good, I feel quality YouTube videos that I have my nurse practitioners watch. Unfortunately, there's not a lot of in-person courses right now, so you're really relying online and in the office training, Yeah. And I also, I would, I have a master's so  I think that there's two components.

I think there's a lot of procedures to the APPs. And then I think there's a lot of that infertility diagnosis and management. That's more the didactic and that's where I lead to an APPs. Also see a new patient and maybe we can chat about new patients and how they can help out with the practice as well.

Griffin Jones: [00:21:55] Let's do that because we really, we need to solve some of the new patient bottleneck that's happening right now. And I spoke with one of our clients today and said is, was that something you'd feel comfortable with letting, an NPC, the patients on the first visit? And he said, no. And so let's have you make, or at least show us the path.

For how it, it could be the alternative. 

Tamara Tobias: [00:22:24] I absolutely think there's a combination there that can definitely happen. And so I yeah I also have heard some feedback from perhaps like an OBGYN I say, well, I'm referring to an RE, I'm referring to the specialist,. Why should they why should I refer them to you then just to see that APP And I would say two things to that I would say one is that we are working together with the RE So we are collaboratively working together. And I really think that's a win-win for that patient because that patient is not, is now getting. Two providers instead of one provider. And I would say that APP, I would also encourage that APP to go out to the OBGYN, to introduce themselves, to do lunch and learns, to let them know that I've been doing this extra training.

I am specialized in this and I'm working together with that physician and we are a team. And so I think that can be a really a win-win, Other ways I see it as nurse practitioners or APPs are focuses on wellness. And I think a lot of patients, especially infertility, patients really want a holistic approach because they're out there, they're out there seeing natural paths.

They're seeing acupuncture, they're trying herbs. They're doing all these things on their own before they even see us. So I think an APP is a nice natural fit. I've seen different models and it depends on how that practice operates. And so I've seen models where the nurse practitioner does the initial intake on all new patients.

So they'll do the complete history, physical, not doing so many physicals right now but do the complete  history start the workup. And then the follow-up council has done by the RE and that saves that RE a lot of time because a lot of the front work has been done already. 

Griffin Jones: [00:24:17] Those patients also convert to treatment more readily, if the REI is only going to be at one of the visits, it's better to be the follow-up.

I can't tell people from a clinical outcome one way or the other, what they should be doing. I'm just saying that people that are in that group convert to treatment more readily. 

So one of the things that you talked about with regard to physician assistants and NPs being involved in this process is how they're introduced to referring providers.

And that dynamic that you mentioned about referring to providers is one of the big reasons that people are nervous about having, not just APPs, but also other. Physicians, like if they hire a new doc, we're worried about pushing some of their waitlists to that doc so that they can get busier faster because it's like, well, Dr. Smith referred them to me and we have that relationship. And I think that's such a mistake. And so I want to talk a little bit more about that and I want to share just. A bit about how we do it in my own firm. And I know it's not the same thing as MD referrals, but people hear me on the podcast. They see me at speaking at PCRS with the red pants or around with my haircut.

And so it's like they're buying group, but the first time that they're speaking with us, it's my, it's not just myself. It's my director of client success, who ultimately is the account manager. And so if. If they are going to move forward, they're talking with her from the very beginning and they know that once they're on the other side of this, it's like, Griffin's not the one handling the account.

It's this other person that came in real early, even before we decided we were definitely gonna work together. And if we decide like, Okay. Yeah. We want to talk about this in more detail. Then we bring in our project manager. And so they're even one level deeper before we ever like ink the paper that, yes, this is what we're going to do together.

So that transition for us has been super smooth. It ties into what you were talking about with bringing the advanced provider along. What else can you do to. Help build that relationship with referring providers and we have an referring provider strategy, but I'm asking you in such a way that I want to know.

When did you maybe I feel like a third wheel and or how can you make sure that the advanced provider that you're promoting doesn't just feel like an add-on? 

Tamara Tobias: [00:26:51] Yes. Yes. Got to get out there. I think if you're new to a new APP to a practice, it's getting out to the OBGYN.  We utilize our marketing people and they're wonderful.

They get these lunch and learns, set up. You can do my webinars. I think that's important to just get that face, let them get to know you and know that you're working alongside that. RE , Another way. So, and then your website, a website is another really important tool because I find the biggest mistakes, and this is my personal opinion, but if you go to a website and it lists our providers, some practices, they only list the REs.

And they don't even show the faces or lists the APPs or who are really working in co-managing and helping these patients. And in our practice, we don't list. Who's they're in alphabetical order. And this is your team. This is your team. Who's working with you. And it's not, there's not this hierarchy.

And that's what I love. I love about our practice. And I think that's an important message for marketing is you're a team. It's not one for over another. And you're providing the service together. 

Griffin Jones: [00:28:04] When we do our episode on physician referring physician strategy, which I think is coming out next month, I'm going to make sure that we give a special shout-out to the APPs for this exact reason.

So, okay. So let's say we've assuaged that concern. What does the REI still need to be doing? Because Tamara I'm thinking of my own primary care physician. I don't have a primary care physician. I of course do at the general practice that I go to. I've never once seen it, my provider is the nurse practitioner and has been since I was 18 years old.

And so I just view that person as my provider. People can say, well, fertility is different. REI is different and indeed it is. So what does the REI really need to do still? Even when we have brought in our APPs, 

Tamara Tobias: [00:29:02] Absolutely. So we talked about different models. And so one model, like I mentioned before is sometimes the APP does the initial assessment, the initial workup.

And then the follow-up is with the RE. Another model is looking at what appointments are appropriate, perhaps for an APP. So for example, look at donor sperm patients, same-sex couples. They go to an REI practice. They're not infertile. Right. They may be a little, they may be subfertile because of their using frozen sperm, but they're not infertile.

And so those are completely appropriate patient population that the APP can see, can manage. And in our practice, we sort of have a protocol, like if they're not pregnant after three attempts of this or that, then they're going to have a follow-up with one of the physicians. And so we can get that initial part done and most will get pregnant right. In those initial cycles. So if they're not getting pregnant or they need higher-tech, and I think once we're getting higher tech where we're talking use of daily gonadotropins, or we're talking, getting ready for IVF, then absolutely those need to see that REI.

I think another, good population can be egg freeze patients. And so, and this can be tricky. I think you're going to need more experienced APP to see those patients.  But in our practice, the APP see a lot of the new egg freezing patients for two reasons. One again, they're not infertile. Two, they need a lot of education and that's what APPs are great at providing education and really talking about what's their family building strategy. What's their goal? What do they want to do in the future? And we have that time to really dive in to those discussions. And then what we do in our practices, the APP does a bulk of that work.

Does all that management. And let's say if I see somebody and she has low diminished ovarian reserve, that was surprising or she's older. I'll do the bulk of the work, but then they get a free 30 minute follow-up with a physician, but then RE. So making sure they have those touch points. So that patient feels like they, again, they have this team working for them. And so I think that's another good population.

Griffin Jones: [00:31:15] Why do you say the APP should be a more experienced one if they're partly managing the fertility preservation program? 

Tamara Tobias: [00:31:24] I think an APP to be more experienced, to just to know outcomes and really understand outcomes from egg thaw, how many eggs, the age of the patient, things that could go wrong. And so I would have them more experience perhaps starting with egg donors.

Working with the egg donor population for maybe six months, eight months. So they really get a good feel of how a stimulation cycle goes, how the response goes, because you need to be able to answer questions. Why am I not responding the way, why did I have 11 follicles at my baseline? And now I only have four follicles and to really have that understanding of the IVF and the cycles and how that works, I think may mean more time and experience. 

Griffin Jones: [00:32:08] When did you see the role of the APP? Start to open up beyond just the third party coordinator role. When did you start to see REIs giving more of that work scope to the APP? Was it five years ago or longer? When did this really start to take off? 

Tamara Tobias: [00:32:28] I think you nailed it. I want to say five years ago.

Griffin Jones: [00:32:31] I think so, right. I know, I've only been here for seven years, so I can't really say, but it didn't seem like it was that way in the beginning. It seemed like there was a lot more people pooing it. And to me, it seems like even in the last, really like since this boom post COVID has taken it to another level, like maybe five years ago, this really started more people were doing, it started to be a little bit more accepted.

There were still some people that said now we're not going to do that. And then, this boom that has not gone away since last June. And it's forced people to revisit it. That's what it seems like to me. What do you see happening? 

Tamara Tobias: [00:33:08] I absolutely agree. I think the last five years, I think the volume has pushed it.

I think they're ,  busy and  they, their schedule is so full and they don't have time to do procedures. And then when they see that the APP  can do that, they're like, that's great. Or the problem visits or these new patient consults like donor sperm. They're like, yes. See them because I need to do my IVF patients.

Those take more time. Those are more problematic. Recurrent pregnancy loss. Those that are, really take longer, they're more, much more high, complex cycles where we can take, we can help and take some of those other cycle management off.  Another thing that happened because of COVID, I'll just comment on is we had that brief slowdown period. But when we did have that brief slowdown period,  in our practice in SRM, we developed a PCOS wellness program and you think a PCOS is huge and affects one out of 10 women. And it's huge. And our RE's do not have time in that consult that initial consult to talk about infertility.

And then. All the things that encompass PCOS is life has,  we could do a whole day talking about PCOS, right? And so this piece was program really now focuses on education diagnosis and managing symptoms and treatment of symptoms that the APP can do. So now here, our physicians were like, yes, have it go, go, because they don't have the time.

So we're doing those consults. We're seeing those patients and if they need to do IVF, then we're, co-managing again, we're there helping them manage lifestyle, obesity, insulin resistance.  We're helping that. And then the RE is doing the IVF portion of it. That's work. That's great. It's taken off. 

Griffin Jones: [00:34:55] It's taking off well with the example that you gave with your group, but it's also taking off that APPs are certainly expanding to their scope within the REI world in a way that we hadn't seen five years ago, I could see the pendulum swinging the other way and people saying, okay, we've got so many darn cases coming in and now new York's a mandated state.

And now progeny just landed 10 more companies. And so 800,000 more people in this state are insured. What have you? And I could see us or people just adding advanced providers and maybe not doing so in a way that's systematic. What problems could come from just doing this too quickly?

Tamara Tobias: [00:35:46] I think patient satisfaction, right?

If you throw somebody in there, there was one nurse practitioner on one of the comments that she made in our survey. And she said she went to the sink and swim university. And I think if you do that , you're setting yourself up for failure and that nurse practitioner is going to leave. You're going to invest time and money to train them.

And. And if they're not feeling satisfied or they're thrown in there, and they're not getting a nice balance of maybe doing procedures and new patient visits, but feeling comfortable and feel an educated and supported in that role, they're going to leave.  So yeah I think you could say your self up for failure.

If you don't invest in time to truly train and educate these APPs and then check in on them. How are they doing? Are you utilizing them to the skills that they're capable of? Do they want to do more? Or do they want to do less? Do they have a particular interest? So for example, we had an APP who really wanted to work with male infertility.

So we hooked her up with a urologist and it was a perfect fit. So could there be a role in your practice for that? And so. Yeah, I think you really, you have to invest and you have to do it right, but you can't go too fast. 

Griffin Jones: [00:37:01] When you check in on them. How are you evaluating your APPs? 

Tamara Tobias: [00:37:06] So for me, several ways. One is we have you can call at any time, right over if you have any question of the day. Then we have routine meetings. So routine meetings, quarterly, and those are like a two hour meeting where we could go through our topics. We have reviews twice a year where we sit down and have a formal review.

 We have peer to peer reviews. And so checking in seeing how they're doing on their patients. I check in with the physician. So all of my APPs have a physician mentor. I think that's really important as well. And cause that mentor is going to be my resource to check in, to see how that APP is doing.

Has there been any patient complaints? Has there been any grievances?  And that's important as well. And if there is, let's go back, like, was there a mistake on a procedure? Was there a hiccup or if there was let's readjust it, do we need to do more training? And really have a process for training. So it's not watch one, do one see.  What does it say? What does it say? See one, do one, teach  one, right? Yeah. No, you can't do that. You'd need to have a process. 

Griffin Jones: [00:38:14] Give us some tips for recruiting nurse practitioners, because  I could see this getting even more competitive than it is now. They're easier to recruit then REIs simply because there's only 40, 44 fellows a year.

They're just by numbers. There's more nurse practitioners, but it's not like they're so easy to get either. And so what's the best ways for recruiting and retaining them? 

Tamara Tobias: [00:38:41] That's a challenge. It can go both ways. So I'm gonna share my experience. I've had new grads and so you could go to schools and try to get a new grad.

The tricky part about that is if they have no women's health background or OBGYN experience in their background. You don't get reproductive medicine and your training, not so much. Right? So it's very focused unless you are a women's health nurse practitioner, you're going to be focused in on women's health.

But if you are a family, nurse practitioner, you're getting everything. And so is it diving down, and if you get a new grad, it may not be what they thought it was going to be. And so I would, then if it's a new grad, I would have them maybe do a, a day where they follow you just to watch. We'll see what's involved with that role before hiring them to see if this is really something that they're interested in .

Griffin Jones: [00:39:32] Not as a means of training them, but just as a means of them self screening, like who I want to get in to this, who do I want to run for the hills?

Tamara Tobias: [00:39:39] Yes exactly.

Yes. I had a nursing student come in to just to watch me for just a couple hours. And she passed out on the floor within the second patient. I was like, 

Well, do you really want to be a nurse?

Absolutely.  The other thing I would look is OBGYN practices. Now this can be tricky too, because you don't want to, but.  It's not so easy getting APPs it's I think it's a tight market everywhere, and we're struggling with medical assistance. We're struggling with nurses, we're struggling with ABP.

So  it's not that easy. you need to be competitive with your salary.  And it, and I think, like I said before, there might needs to be some in like observation first before you invest the time and money for training and hiring. 

Griffin Jones: [00:40:31] I suspect that matching of interest that you mentioned for the one example that you gave would be a recruiting advantage as well, because to a certain degree, depending on what market you're in, you may or may not be able to go to the top of the market for the salary that people are getting if there's a lot of demand and you're in LA, for example,  you might just not be able to do it if you're a smaller practice, but if you can say, okay, we have a few APPs and this individual wants to, I'm putting sub-specialized in air quotes, but  in male infertility, we should be able to give them that trajectory. I suspect that's one way when you can allow somebody to pursue the academic pursuit that they want, that gives you a little bit of an edge when you can't make up for it in material benefits. 

Tamara Tobias: [00:41:24] Yeah.  Another thing that we've done in our practice, we have a yearly conference this year was online, but  we do an outreach to the OBGYN community where we educate and train. And a lot of the program development of many of speakers are APPs. And so it's fun for a way to introduce what the role is and what is involved for people that have no idea. They may come out of school and they have no idea that this even exists as an opportunity.

Griffin Jones: [00:41:55] You talked a bit about what REI is, can understand better and more deeply about APPs. And now I want to flip it and giving you this seat to flip it, because I also want to make you blush a little bit, because I'm not gonna say who it was, but one person weren't said about you. They said that there's a handful of advanced providers in the field that the physicians look to as peers and Tamara is one of them.

And so I'm going to let you flip the script and say, what is it that APPs need to better understand about the REI and what they're going through?

Tamara Tobias: [00:42:33] I  think for me, for maybe for me, I just had such a passion. I've always had such a passion in the field and wanting to advance and grow and learn and just take it in another step further. And I think I've had RE's reach out to me actually and say, Tamara, I want to hire an NP. How do I do it?

How do I even start? And  I'm happy to share my orientation, checklists, my protocols. I have so many protocols and SOPs and what I feel is reasonable  for an APP, but understanding the boundaries too, because we're not an REI and I never, ever want even, I mean, that is such a specialty and I have  the utmost respect for all of our physicians. And I feel like I am there to help these patients and sometimes to help them and move them along that those, their journey, right. 

Griffin Jones: [00:43:29] You've given us so much to consider with how we bring APPs into the REI practice. How do you want to conclude for our audience Tamara?

Tamara Tobias: [00:43:38] Love the APPs, utilize us where we, I think there's practitioners, especially nurse practitioners who have our, we have nursing background for the foremost in that nursing. Component that, that teaching in us, the wellness, being a coach, being an advocate, just providing that empathy per patients, if they can see how we will work together with you. We are not out here to.  Take patients over anything like that? I would say I, especially in our practice, I see such a love for our APPs now and really looking at how we help grow the practice and we can help increase the revenue in the practice and we can free up time for REs who really need to be doing all those complex cases and that patient management. 

Griffin Jones: [00:44:28] And give people like me, marketers like me someplace to send all these patients. So God love you. Tamara Tobias, thank you so much for coming on Inside Reproductive Health. 

Tamara Tobias: [00:44:39] Thank you. It was my pleasure.