Monash IVF’s busiest doctor says she left the company after more than 17 years because of bullying, frustrating internal politics and a tall poppy syndrome that meant she could not treat her patients the way she thought was best.
Lynn Burmeister, dubbed Melbourne’s “fertility queen” by The Women’s Weekly in 2013, resigned from the country’s second largest IVF business in March last year.
Monash IVF initially downplayed the resignation in an ASX release in June 2017, however Dr Burmeister’s exit triggered legal cases, a $12.3 million drop in annual revenue, lower earnings forecasts, questions about the validity of industry-wide doctor contracts and now, has opened up claims of bullying.
“Nothing can be as hard as last year,” Dr Burmeister tells AFR Weekend, talking for the first time about the circumstances that led to her resigning from the $264 million IVF provider.
Final trigger to leave
In a wide-ranging interview Dr Burmeister says the final trigger for her decision to leave Monash was a policy where the company would no longer provide administrative and staff support for doctors who offered “adjuvant” treatments to their patients.
She says that was the culmination of years of being sidelined by her peers, and in medical decision making, despite being the company’s busiest doctor.
Adjuvant treatments are commonly used by IVF doctors, and can include vitamins, low-dose steroids, klexane and other methods that in some patients could improve pregnancy rates.
“If someone is not getting pregnant, you’re going to try other things. You can’t keep doing the same, same, same,” she says. “If you read an article and it looks like something may work, and it’s not going to cause your patient any harm, of course you want to try.”
Dr Burmeister says she was told about the policy change in November 16, 2017 by email from the company’s Victorian medical advisory committee. In subsequent meetings, she was told it was a company-wide policy but later met an Adelaide-based Monash IVF doctor who told her he was still using adjuvant therapies, and the company was helping him manage the process.
Before the change, doctors filled in what is known as an “activation form” which prescribes therapies, and staff nurses would help manage the process.
“This was a specific policy designed to hobble Lynn,” one Monash IVF employee, who asked not to be named, told AFR Weekend.
But Monash IVF denies this.
“Any claim by Dr Lynn Burmeister that she or her practice may have been targeted by Monash IVF Group is wrong,” chairman Richard Davis said in a statement.
“Monash IVF Group is disappointed that Dr Lynn Burmeister left the group for what we understood to be commercial reasons. Despite our best endeavours to retain her services within the group, we respect her right to pursue career opportunities elsewhere and we will honour and enforce the terms of her departure from Monash IVF Group that both parties agreed to last year.”
Tall poppy syndrome
Dr Burmeister was the company’s busiest doctor, averaging 1200 or so cycles a year. A doctor who does 500 cycles is generally considered busy. In IVF, a cycle refers to egg retrieval, fertilisation, and then possibly, an embryo transfer.
In the company’s most recent annual results released in August, it disclosed a “specialist departure” had triggered a $12.3 million fall in revenue and forecast its first half earnings would fall 15 per cent because the previous period included one quarter of activity from a departed specialist. In June 2017, the company said Dr Burmeister’s resignation would not be material in 2017-18 and could cause a high single digit decline in net profit after tax which “may be offset by other market opportunities”.
She says it’s difficult to explain the company’s policy change around adjuvant therapies.
“It might be a bit of tall poppy syndrome,” she said, noting that it may also be a medical difference as some doctors prefer to practice in a more evidence-based way. “But many things we do in medicine aren’t evidence-based. That’s how new discoveries get made.”
After Dr Burmeister resigned in March 2017, she says the company sent an email reversing the changes, and reinstating the adjuvant therapies on the activation form.
Mr Davis said adjuvant therapies were managed by doctors.
“The policy at Monash IVF Group is that the individual doctor is responsible for the management and delivery of adjuvant therapies to their patients. Ultimately, the decision regarding the use of adjuvant therapies is a decision for the individual doctor and their practice.”
Dr Burmeister had been on the Monash IVF medical advisory committee, which represents doctors within the company, since 2013. Doctors are voted on by their peers.
“Strangely enough I got taken off in 2016,” she says. “I was replaced by a doctor on the committee who did substantially less cycles than I did, and I no longer had a vote in company patient management policies.”
Dr Burmeister said she was also concerned by the company’s decision to try and “own” the patients, rather than have them deal directly with their doctors. Patients were directed to ring the company rather than their doctors at critical times, such as the first day of a period, which would determine the timing of the next egg collection or embryo transfer and drug administration.
“It became untenable, it became a situation I couldn’t work in,” she says, noting she was staying back until 1am in the morning trying to manage patient treatments without the support of the group.
Dr Burmeister said there were a number of events during her time at Monash where she felt bullied and uncomfortable. These included having a sign with her name on it outside a hospital gaffer-taped over to obscure her name, and the time a colleague publicly ridiculed her at a staff Christmas party.
“I was told by several people one doctor got up and ridiculed me, saying ‘If I had red hair and stilettos, I might be the fertility king’,” she said, adding she ran late to the party but was told when she arrived it was fortunate she hadn’t been there.
“It’s still very hard for girls in medicine, just getting in as a female. It’s still hard,” she says.
The company says it “prides itself on a collegiate and collaborative culture” and does not tolerate a culture of bullying.
Patients before profits
Despite her departure, Dr Burmeister says concerns that a listed IVF company fostered an environment where doctors were expected to put profits before patients are unfounded.
“I don’t think there was ever that thought you had to get the patient in and out. It just wasn’t that sort of environment,” she said. “You never got told you had to push more patients through.”
The increasing role of corporate players in the IVF sector – Virtus IVF, the country’s largest player is also listed on the ASX, and Genea, the third largest group, was sold in late August for more than $300 million to a Hong Kong-based consortium – has fanned fears of doctors giving false hope to desperate people in order to drive profits. Success rates vary and in many cases, are highly reliant on specialist doctors and scientists.
Dr Burmeister’s decision to challenge the onerous doctor lock-up contracts has the potential to disrupt the industry.
Her July 2017 settlement with the company restricted her to practising outside of Melbourne during a non-compete period.
But that left her able to provide IVF services in Geelong, where she also established a lab at Epworth Hospital. Dr Burmeister opened an egg-freezing clinic Number 1 Fertility in Melbourne months ago.
Now, with her agreement with Monash having expired this week, Dr Burmeister says she will add IVF services in Melbourne and has ambitions to open in Sydney. She says her clinics will be able to compete on price and science.
“I’m still seeing the same number of patients if not more,” Dr Burmeister says.
“I don’t have shareholders, and I don’t have CEOs and I don’t have the layer of fat the big companies have,” she says. But she noted the set-up costs aren’t small – a specialist microscope can cost $250,000.
Dr Burmeister was trained by Carl Wood, an IVF pioneer. Dr Burmeister says she has wanted to be a doctor since she was at school, and after studying at Melbourne University she “fell in love” with obstetrics and gynaecology. In addition to Monash, she also spent two years training in New York with Zeb Rosenwaks.
She questions why younger IVF doctors would want to sign onerous contracts, but says leaving is challenging.
“I know so many doctors [across the industry] that do want to leave, but I don’t know whether they will because they saw what I went through,” she says.
Monash IVF’s Mr Davis disputes this.
“The vast majority of our doctors are contracted to Monash IVF Group, as was Dr Burmeister prior to her giving notice. Furthermore, it is the benefits that Monash IVF brings to these doctors and their patients that keeps them working with us, not their contracts.”