Episode 5: Peter Antevy on When Not to Sell

Welcome to School of Thought. I'm your host, Joe Polidoro. Dr. Peter Entevi is a physician and entrepreneur who built his business on thought leadership. His firm, Hantevy develops life saving software used by pediatric and adult first responders in hospitals in all 50 states and abroad. Peter learned early on that direct selling didn't work, but thought leadership did. And as a result, he's one of the few physician entrepreneurs who have built thriving businesses that have improved patient outcomes. Peter, welcome to School of Thought.

Joe, thanks for having me. Happy to be here.

Let's start by understanding your original business challenge. Your first insight was that you weren't happy with pediatric resuscitation techniques. They were complicated. They stifled innovation. What exactly was happening and what was your business solution?

Yeah, so I trained in Los Angeles and Pittsburgh, considered two of the top 10 children's hospitals. Pediatrics and then in pediatric emergency medicine. It's a six year process. You're supposed to be the smartest guy coming out of those places. And I show up here to South Florida, where I'm from, start working in a level one pediatric trauma center. Basically.

All the bad stuff comes to us. So it's supposed to be the people who know everything. In 2005, two big events happened to me. One, I made a tenfold medication error on a four year old child who was having a severe anaphylactic reaction. So I gave her 10 times more epinephrine than she needed. She did okay. Thank God.

You were attending physician, right?

I was the attending physician. I'm a pediatric emergency medicine physician. Got it. I was running the show and I was making the mistakes. And then another time where there was a child who the parents had rolled over and slept on their little infant, newborn infant, and the child came in a cardiac arrest. And I had to know all these different medication dosages, the equipment size, all off the top of my head. And I recognize, number one, I'm making medication errors. Number two, they're asking me questions, dosing and sizing that I don't know the answers to. And the tool that was supposed to be used during this situation, nobody used it, nobody liked it, and everybody had created some sort of workaround. I ended up figuring out a way to overcome that challenge and implemented it in my own practice. Some embarrassed about it. I didn't tell anyone that I had figured something out, but everybody noticed that, hey, all of a sudden you've gotten really good at this stuff. And I kind of blew it off for a couple years until finally one day they asked me to Give a talk. And at the end of my talk, they said, can you teach everyone this little trick? And I gave the talk, I showed the trick, and 50 people of the 200 in the audience stood up, and they only wanted my last two slides. And that's when I realized there was a big problem. And that set me off on the journey that I'm still on today, which is to try to help others who were or are in my same situation.

Why were you embarrassed when you came up with a solution? Why were you embarrassed to share it? I'm just curious.

That's a great question.

When you're an emergency medicine physician and you're the lead of the team, everybody in that room looks towards you, looks up to you. They want you to be that person. So in your mind, so you have. You have to be a certain type of person. But then the other side of that coin is there's a lot of expectations people are putting on you and you're putting on yourself. And I was this guy who came from these top programs, and there was shame there. And if I didn't know how to.

Do something, is it a matter of pride or ego?

You know, you call it ego, call it whatever you want to call it.

But you'd been conditioned not to allow yourself to make any mistakes.

And this happens throughout medicine. And I actually just got finished reading a book about errors in medicine, and it was a whole chapter on shame. So here it is. I just finished it last night. I brought it to my office, put it on my shelf. It's called Oops. Why Things Go Wrong. Understanding and Controlling Error by Niall Downey. There's positive shame and there's negative shame, or I think they call it a toxic shame. And the shame where you feel like you're supposed to not be the one making the errors, and you have to go and explain to someone that you made an error. It's rampant in medicine that errors are never exposed publicly.

Nurses and doctors would more than likely run away from the error than go to the patient and said, we've committed an error.

And that's one of the biggest problems in changing the thought process in the house of medicine as to remove this shame. And I have to say, I was ashamed of myself for not being able to run that code with the tools that were standard in the industry.

Yeah. Having come up with a solution was almost an admission of a previous error up to that point. Yeah.

Because back then, now I speak around the country and I tell people about my mistakes. It's taking me time to not get emotional about it. Taking me time to educate others about it. But back when it was happening, I was never, ever wanted to tell anyone that I didn't know something, I wasn't good at something. Because these are the same people who tomorrow are going to be with you in another code, another resuscitation, and they're going to be looking at you thinking this is a guy who has zero confidence in himself, so you cannot have that face and therefore you keep it quiet. And interestingly, when I came out with my solution, I was belittled. I was ridiculed by my own colleagues who they themselves could not run a resuscitation properly because I saw it with my own eyes. But they refused to believe that there could be another solution. It's a fascinating psychological viewpoint, if you will, with what happens amongst doctors when you're talking about medication or medical errors in general. Fascinating.

Okay, so that led to the development of the hand tapping method.

Yeah. Our main product now is a software that comes along with an education.

But the initial solution was.

Understanding the eight medication doses just by being given an age of a child. Whereas before, if I had a one year old in cardiac arrest, I would have to take a measuring tape, measure them from there head to the heel, and then wherever the heel ended up, on that tape, they were listed about 40 or 50 different drugs. And then I'd have to get the dose, do another mouth calculation to get to the volume. And this is all while mom and dad are looking and while the child's dying in front of you?

Yeah.

Whereas what I did, I just said, okay, I figured out a way to just give me the age one year old. And then the dose of epinephrine is one ML. It allowed me to go from a number age to a volume dose in an instant.

And that, you know, skipping the other steps, not just save time, but it allowed the entire room, the resuscitation room, to just feel at ease. And everything was just working very smoothly. And then in 2016, we then built an app, a mobile application which is very highly customized. So let's say you're living in, you know, let's call it San Antonio and you're a paramedic in San Antonio Fire department. We know every single drug, every concentration, we know the protocol, all that gets ingested into the application. So if you're a paramedic in San Antonio with a two year old drowning, you're on two year old, you have all the volumes listed. So there's zero math anymore. When people are using our Software. But although people love it, if I were to go take this app today to a city that wasn't using us and say, here's an app, it's customized. Have a great day. We would come back in a year from now and nobody would be using it. Nobody would be using it.

And the reason would be.

And the reason would be is because people have been told, you must use that length based tape. And that's the gospel. And anything else is not correct. So I spent a decade, Joe, having to change hearts and minds when nobody knew who we were at the time. We had no research. And so what we've learned now, that when we go into an agency or a city and we tell the paramedics here, this is who we are, it has to come along with the story as to why the change has to happen. And there's a lot of data in there. We look at their own data from their own city. We say, take a look at the last two years. How many pediatric cardiac arrests have you had? How many of those kids are walking today and talking and they're alive? And the answer is almost zero in almost every single case. That's the eye opener for them to say, hey, maybe what we've been doing for that long didn't work.

And so now we come in with an education that explains the why, which nowadays we have to do less and less of because our brand has taken over and people know that everyone else around them is using us. But that journey, Joe, my God, I mean, it was so difficult to go through.

You had started off by trying to actually sell what you were doing to.

Medical directors, paramedics, right? All of my, all of my.

And that didn't work.

No, it was an epic fail. And I'll never forget, I was in San Diego for the national. It's called the national association of EMS Physicians. It's a, it's, it's our national organization, right? Thousands of, of EMS medical directors, we all meet up every year, right? So I had just created this thing. We. I finally had some things to show, so I brought, you know, that back then we had built like a box of equipment that came along with the system. And I would come to this big association meeting and people would literally see me coming. They would walk the other way. They wouldn't make eye contact with me. Ever since you're in medical school, they say you do not talk to these pharmaceutical reps and so forth. So here I come as a, as a fellow colleague. And as soon as they saw that, oh, he created something he's going to want to sell it to me immediately. They wanted nothing to do with it.

Yeah, yeah.

And then. And then fast forward to when we were actually getting some people on the phone, some prospects, and we were. And then it was just my wife and I at the time. And the phone would ring and that they would have a question. And I answered the phone and they said, Is this Dr. Entebbe? I said, yeah. They click hang up. And I said, they don't want to talk to me.

You also found that doctors expect a physician to give a life saving discovery away.

Right.

You couldn't sell it.

I realized early on that I could not be at least one iota giving the image that Peter Antevi, the doctor, was selling something that could save a life. My wife, who's our CEO, she says, we have a family. You can't keep doing this.

Right.

I said, but it's saving lives. And she said, well, if you want to save a lot more lives, we have to fund this thing. And if you want to become better and bigger and have more features and this and that, then we have to start charging for it. So thank God for Allison, because she was a thousand, thousand percent. Right.

And you have a sales team now.

We have a very, very nice sales motion here.

We have a VP of sales. We have a bdrs, bdms. And that works. That's the only thing that works. And I only come in now when the client wants to have face time with me personally.

Right.

But during the sales cycle and during the sales process, almost exclusively I'm not involved. After they become a customer, then there's no selling anymore because now it's okay. I'm just giving them expert advice, I'm talking them through some items, protocol questions that they may have at their own system. But the sales process, it needs to leave me out of that.

But it's still very important that you're never seen as selling hand tevy, Is that right?

Yeah, you're 100% right. And the way that I'll say this is, you know, a lot of people who are in the earlier journey that have come to me and I'm helping them through and I'm seeing all of them are going through the same exact process. So it's not unique to me or the product that I created. It turns out that when you're in healthcare and you're taught to do something one way, and then someone comes in and says, joe, I know that you're a physician and you've been a simple example, you Give this antibiotic every time someone has an ear infection. And that's your standard go to. And now someone comes in and says, joe, I have this other antibiotic that is incredible. Your first inclination is to say, shut up and get out of my office. So in healthcare that is the first, the first feeling you have is that feeling in order for you to get to actually change that physician's mind.

There has to be a lot of touch points. And the touch points deal with different things. So obviously first you have to hear of the concept. Great. Then you want to hear from your friends about it. Are any of your friends doing that? Then you're going to be at a conference and you're going to hear someone give a talk on that on set antibiotic. And then you're gonna go back home and you're gonna do your own research on that antibiotic. Right? And then you have to hear it again. And then that person who told you about it the first time may have to tell it to you a second time. And here we go. Years are going by until finally you may actually change your practice.

That's what you call the valley of death, that long period when you're building trust, if not cash flow.

I tell people it is a 10 year journey until the healthcare. That the house of medicine in general will even open their eyes to look at you and say, okay, this is a legitimate company product, software, etc. That I now am going to open my heart and mind to, allowing myself to commit to making the change. Mm.

So events, blogs, videos, how do you decide which thought leadership formats to use and how do you deploy those formats with different audiences, different kinds of buyers?

That's a great question. I'm going to start with the last one first, which is the customer segmentation. When you look at ems, these are very straight shooters. They're very common sense people. And there's very little red tape in, in the EMS industry. Meaning that if you have something that's of value and you can prove the value, you really have to go to one person at that one agency who's a decision maker and that person can say, you know what, I believe you, we're gonna do it. And as, as an EMS medical director myself, and I have smaller agencies and I have really large agencies, I see this on a day to day basis, right? Where I see something come in, I present it to my team, they like it done. The other segment, which are physicians looking at them independently, we already talked about how they're very resistant to change. But then when you look at the hospital segment, that's a whole other animal. Because you typically need four to five threads to be pulled at the same time. And if they're not pulled at the same time, you're going to get screwed later because that last person is going to come in who knows more than anybody else in the room, and they're going to block the whole process. So you have to pull along the. You have to have an internal champion, you have to have the cno, you have to have a medical director, you have to have the IT person, the CIO involved, the head of the icu, the head of the er, and oh my goodness. And all those people, you have to coordinate their schedules and do that all at the same time. It is almost impossible. We would be bankrupt if our only customer was were the hospitals. Because the people who pay for the product are not the people who use it. And therefore they don't see the value that the end user would see. And the clinicians have zero say in what happens in what is purchased. They're just given things.

And it's very hard to find a physician who's burnt out not getting paid as much as they want to. The working nights and weekends to then go fight for Peter Mantevi when they have. They have no reason to fight for that. Right? So we do. We are in 80 hospitals today, approximately, give or take. And some of the biggest hospitals in the country, Cleveland Clinic, Memorial, Herman. But the reason we're in those places, Joe, is because they heard about us. They said, ah, okay, whatever. And then they had another bad outcome. So we get another phone call, hey, it's us again. And then they think about it or it falls along the line of these five threads. Okay, fine. Third time around. Okay, this time we really, really, really want to go with you guys. And we said, well, that's what you said last time. So the hospital is a tough nut to crack when it comes to thought leadership. Initially, what worked for me, and I still do it till today, is I pack my bag, I get on a plane and I go to the place and I give a talk and what dad has done. And again, I don't talk about the products. Like tomorrow I'll be in New Hampshire. They all. The whole place already uses hand Tevi. There'll be a few people maybe who don't, but I'm giving a talk that will not talk about him Tebbe, at all. And that's what I did for many years. I'd go, I'd fly around and at the dinner people will be like, oh, so tell me about this thing that you're creating. And they attached a human being, hopefully, that they like, with someone who is doing, who didn't come up and try to do a sales job on the stage, right? And then they. I plant a lot of seeds during my lecture for them to be introspective and understand what is really happening at your shop. And what happens is they go back. Then all of a sudden we get a phone call, hey, we want to learn more. And it's funny, I tell my wife, so now I charge, I have a speaking fee and the whole thing. And now I go out there and I still do it today because.

No matter what that human touch and for people to see me as a real human being and someone who, like, when I'm up on the stage, I'm like, I'm. I wouldn't say that I'm emotional, but, like, people can hear the emotion in my voice because I care about that next child living or dying. And that, I think has helped.

When our sales team ends up getting these folks, many of them feel like they know me.

Because you're all over social media, right?

I've transitioned to social media, and if you go to my YouTube page and scroll all the way to the very bottom, you'll see the worst video ever. And that was one of the very first videos that someone told me, take out your iPhone. Because I like to write content. And they're like, pete, just get on the video. And those videos on Facebook would. Would fly. I mean, we're talking hundreds of thousands of views. Blew my mind.

Who was viewing them?

Paramedics.

Paramedics.

It was par. It was paramedics, paramedic leaders, you know, nurses, doctors. But it was mainly like.

Our crowd, if you will, is ems.

And that was mainly Facebook. Are you still focused on Facebook of late?

In the last, let's say, three years or so, Facebook has kind of dwindled. And it's all about LinkedIn. And then we put a lot of videos on YouTube.

And what I've tried to do is if you look up my content on either on the Hentavi YouTube site that I have, I have two other YouTube sites that have nothing to do with hent heavy. They all have to do with high value EMS content.

Content that even the best EMS clinician out there will look at the content that I put up and they'll say, huh, I never thought about that. Oh, wow. And all of my content is backed up with data. Either I'll tag it to an article or I'LL put data in there or my own data for my own agencies.

Right.

And so now if you ask people about who is Peter Anteby? Most people will probably tell you that he's an EMS medical director.

Very few people will say, oh, he's the guy selling you a product. Yeah, I think they all know that I'm associated with Hand Tevy. But when they're out there on social media, they'll never. Maybe there's one or two videos that they twisted my arm here at the office.

That I put up online about the product itself, but there's 99% of the time when you see me, it's on something related to this profession. And I become like the de facto person.

Trying to take this profession and leading it into the next.

Kind of bringing it up another notch with respect to data and research and training and education and trying to motivate the crowd, the men and women in the field who are doing the hard work in the field, trying to inspire them that they mean something, that they matter, that we care about them. And so when I go to conferences.

It'S all the line paramedics who come up to me and, you know, I get a lot of thank yous. Nothing about Hand Tevy for the most part.

Right. With all that you still want to accomplish, how will you use the different ways of getting thought leadership out there? You started with events and clearly events are still the centerpiece.

Right, Right. So that the in person thing kind of really helps solidify. Like it's the most solidifying thing that I can do from the, from the company's perspective. However, however, there's two segments that I see as far as social media. Number one segment are the hundreds of thousand paramedics out there who are doing the work. They're not decision makers per se at the agency. They don't have really decision making ability. They're not writing the check. But these are folks who, they love what they do, they believe in what they do, and they, they. We have a very special bond and relationship that when I put out content, I know that they're listening to it. Because when I travel around the country, everybody says, I love that content. I put it up, I make everybody watch it. So there, there's. I put up content very specifically for the clinician who's doing the work. Okay, that's, that's number one. And then what happens is those people end up clamoring and saying, hey, why aren't we doing what he's doing? How can you. How come our protocols aren't like his protocols. And so I kind of create that stir in the pot because many EMS systems out there don't have medical directors who are involved, engaged, who are innovative. They're kind of stale and maybe the medical director is not even involved. So it forces those agencies to then kind of look at what they're doing. And that's how we get people at the top to actually know who I am. So they're being sent my video over and over again. So that's helpful. But then on LinkedIn, less on Facebook. So LinkedIn and Twitter, where I have about, you know, let's say 16,000 people who follow and most of those people are in link leadership positions. Their government.

They'Re running hospitals. Kind of all those types of people.

I put on content there that's really very high level. Clinical, managerial, administrative, data driven, research driven. And the thing I'm trying to point out to them is, hey, here's a guy who is, is managing the department. I'm not just an academic somewhere writing papers, but I'm actually in the field. So you always see me putting pictures of me out there in the field in the back of the ambulance or with my paramedic students. So like I'm out there and then showing them that we're research focused. So I'm always talking about research, research, research, including the research that we publish. And then I'll talk about administrative like leadership type things. And the message I'm trying to put out there is, here's a guy who cares about this profession, he's trying to lead this profession. He cares about the people, he cares about their well being, he cares about the medicine, he cares about the outcomes. Just the fact that I care about this profession, which I like, there's no better profession meant for me than being in the profession of ems. And I think so. That's the kind of image I'm trying to portray. So that when those guys and gals on the ground are saying, hey, and Tevy's saying this and Tevi saying that, all of a sudden they're thinking, oh, it's the same guy I'm seeing on LinkedIn. Seems like a good guy.

Can you quantify the return on investment of the different kinds of thought leadership you produce or point to? Any direct sales?

Before this interview, I went to my VP of sales and I said, patrick, I'm about to be on a podcast. And they're, you know, he's going to ask me how does this whole branding thing that I'm trying to do in thought leadership how does it impact what you're seeing on the sales side? And he says, you know what? I would have no idea of knowing that, except that everybody knows you. And every. When he gets them on a webinar, they all say, love to follow Dr. Antebe on, on video. Tell them to keep putting out more content.

So we cannot quantify it, but.

There'S some sort of branding value that's happening, but there's no way of us knowing.

How to quantify it. There's no KPI I can follow to.

Determine that other startup founders in your industry must seek your marketing advice. What do you tell them?

I've been trying to help some other people do the same thing that this guy Mark Peel. Dr. Peel.

Right.

With his lifelong infuser. Many years ago, when I first met him in 2015, I said, Mark, I want to do exactly. I want you to do the same thing that I'm doing because I was a few years ahead of him.

Yeah.

And now he is. He's. He's here today in Miami Beach. He's speaking at a conference he was speaking at. So, like, so he's on the circuit now, speaking. And everybody knows him now as not the guy just selling the product, but the guy who's doing the research and speaking and teaching and educating. And just recently I said, I said, mark, I'm not seeing you on LinkedIn. So he, the other day, it was like a Saturday night, he puts his first, like, real post and he texts me like, look, 800 people saw that. I said, mark, it's going to be tens of thousands of people once you build up that thing and you're not talking about. I said, do not talk. Talk about your product. Talk about everything else. Talk about the problem. Talk about this piece of research. Talk about something else. Just don't talk about your product. And. And so finally now he's getting into the social media realm and understanding the power of social media. Because to your question earlier, when I go now around the country, I'm known now more because of my social media.

Yeah.

And because people kind of know who I am because of the social media and the videos, period.

Right. Don't sell. And that's a clear message you're recommending. What else would you tell people who want to replicate your success?

Yeah, yeah, I think, I think I have a couple of ideas here. Number one is that you have to just be persistent and consistent. So as an example, I do something called the Florida EMS webinar. Every Friday at 11am people know where to tune in Live. And what I've done for that is, you know, I use some AI to help me so I can do all the scheduling pretty simply and the email generation and everything. But basically I find an article a very, very high value EMS research article. For anyone who's listening, who's ever done research, you know that you spend years of your life doing the research. It takes another year to publish it with all the back and forth. The editor, peer review.

Sure.

And then it finally gets published and then you're sitting at home and it gets published and nobody calls and nobody writes and no one cares, to be quite honest. Yeah, so. So I, I curate the, you know, all these, I, I curate this, this show, if you will, where I pick out the best of the best. I throw it into my chat GPT it spits out an email that says Dear Dr. XYZ, I read your article and I loved it because would love you to join the Florida EMS webinar. Here's our YouTube channel. You can see the 185 talks we've had. Here's a calendly link schedule. You're the. I haven't gotten one. No, I'm booked out until the end of January.

And basically I don't do any prep except I read their article and basically I, I opened the Zoom on a Friday at 10:45. They started 11. They give their 20 minute talk. I publish it to YouTube and it's now there's 185 talks of not just like the basics but this is all like all the innovative things that people are saying. You have to see that webinar because that's what the future of EMS is going to be. So be persistent, be present, but make sure that you're there and it's not just spotty, right? Oh, I see him now one week and I haven't seen him for 10 months.

I think that's an easy one. On our Facebook page I do three blog posts a week, all on research. Then I summarize the research and I link the paper and then on Twitter where it's more of the, you know, there's although I have like what, 15,000 followers, it's probably just a true maybe hundreds of them who are also leaders in the field who that's who I'm speaking to because it's more of like a little friend group Twitter is if anything else that's probably not where we get any of our, of our leads from. But there is also where just putting things that will make even the top physician at the top Hospital scratch their head and say, is that, is that real? Like, is he really, is he really telling us we haven't done that ever? So it's been a fascinating thing that it took that, that took many, many years to evolve into.

Yeah.

But I'm very thankful that I did it.

Many years ago because now when they bury me six feet under, it's not going to be he's the guy who created a product and. Which is what my biggest fear was, by the way.

What would you like to be said about you instead? What do you think will be said about you instead?

That's a good question. I would say that number one, I think, for people who know me is that I care about people first. Right. I care about the people that I work with at the fire department. I'm just so in awe of the work that they do. They put their lives at stake on every single call on the side of the highway, etc. And fires, all that, all that. So I think people will say, people who know me and of me, that I care about people first.

And then the other thing is that I'm adamant that there's a lot to be done in healthcare, whether it's treating children better, right, with medication dosing and saving lives with resuscitation training and practice, etc. But then we have done so many other things related to adult strokes, adult cardiac arrest, trauma care, we put whole blood in our ambulances in 2022 when, I mean, back then people thought we were nuts. Now I'm leading that charge to help stimulate that to go around the country. So I like to be on the leading edge of healthcare and EMS allows me to do that. So I would like people to say that he cared about saving lives through innovation, research and education. And if there's another one human being that could be alive today because of that, that's really the most important thing for me because I've seen the other side of it. I've seen when children die, then you see suicide, you see divorce, you see alcoholism, I've seen it all. And.

It'S like a nuclear bomb that happens inside of a family. And if I can help prevent the one death, then I know that I'm preventing so much more beyond that. And then you have the firefighter and paramedic suicide issue. That's another big thing that I try to focus on is our own emotional well being of the providers who are doing the work.

So what's interesting is that I see it today as there's so many things in medicine that are just being done incorrectly because the foundation that those concepts are built on are basically a house of cards. So there's so much to fix in the house of medicine that doesn't even require like something new and exciting. It just requires us to go back and look at all these foundational things that are just so wrong. That's really what I'm focused on today. But there aren't that many people who are willing to challenge the status quo, unfortunately, in the house of medicine today, for whatever reason.

Dr. Peter Entebbe Great talk. Thank you so much for your time.

Joe, this has been fascinating. Thanks for having me on your podcast.

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