BoneChat #109 - random intimate discussion

Didn't see that.

So I think it just popped up, but you know how the algorithms work.

Yeah, we all see different stuff.

Yeah, I interviewed a young man this morning, uh, who was born in Russia They moved to Kazakhstan when he was 2. From there, uh, to Israel. He said his father got the green card lottery. He went to high school in San Francisco, went to college at Middlebury. Speaks Russian, Hebrew, Japanese, Arabic, Spanish, French. Wow. He's in his 20s. So he works at Oracle full-time, but he's trying to cultivate a, I wouldn't say lead generation business, but kind of a meeting generation business. And a friend of mine in San Francisco who went to high school with referred him to me.

Wow. Interesting.

And I told him, I said, it's a constant challenge and discussion in the orthopedic world. On how do startups make new business. Yep. So I told him I'd talk to him at 7:00 AM tomorrow morning and more on it.

So, wow.

But he was an interesting guy.

Yeah, he'll, he'll do well in life, I'm sure, if he's that flexible and that smart to, uh, accumulate all those skills early.

He got a full— I talked to the guy that referred him to me in San Francisco, a good friend of mine that I'm actually— he's a business partner. We do lead generation together. Josh, he— we had him on your program.

Yeah, yeah, Josh was great.

Yeah.

And, um, he told me he's— the guy got a full scholarship to Middlebury.

Wow.

And for liberal arts.

I mean, the people that come out of Russia or Soviet Union, Ukraine, are just so industrious.

Well, the ones that make it to us Yeah, not the ones that, not the ones that sit, sit there and drink themselves to death.

Yeah, Laura Land and I have a, we have a common friend, uh, Irina Timmerman. Um, you're on mute, Laura Land, but, um, she, she was, uh, she worked at Wright Medical for, I don't know, 30 years, maybe 40 years.

She retired? She must have retired.

I think she retired, yeah. I took her out to lunch one day. I said, "Loreline, tell me your story." And she was born in the Soviet Union and the family faked a vacation to Italy and they just packed suitcases and they checked the suitcases when they left. They left their house, their cars, everything. Didn't tell anybody. They went to Italy, and they had an arranger to get them to the U.S. And they said, you can either go to New York or Memphis. And they— she— the father picked Memphis because they said, if we go to New York, we'll never learn English. We'll hang out with— in the Russian community. So they went to Memphis. She had a— she was really smart, and she had engineering degrees from the Soviet Union. They didn't recognize them. So she started all over. Um, she— and they had no car. They lived on Summer Avenue, which was a few miles from the university. So she enrolled brand new, walked to the university every day and walked back. I mean, just incredible.

And it's close, but it's not that close. I mean, it's walkable, but it's a long walk.

And she didn't lose New 4-year degree, ended up at Wright Medical and hip-knee development. I think adversary is really important in life and careers. I think you have to have big obstacles. You know, you see the trust fund babies don't do well usually, but the people that come from nothing really do well a lot of times.

I've come to learn that if somebody wants to introduce me to somebody and I find out they're of Russian Jewish heritage, I, I, I take that call ASAP. Yeah, because that's Josh, that's his heritage. The guy I interviewed this morning, that's his heritage. I'm sure that's Irina's heritage. Um, my friend Julia Komisarchek in Salt Lake City, that's her heritage. Her and her father, they, they're always driven. They don't take anything for granted, um, and they're just, they're always extremely aware of their surroundings. And that's kind of, that's one thing I learned in Vietnam, that everything Oh, you froze, Mark.

Yeah, we lost him. Ah, oh no, you may have to go off and come back on. Yeah, he probably is going to have to.

Hey, Lauralyn, did you— Mark was saying that Anne sent out a note. Did you have to RSVP again for the—

I, you know, it didn't show up automatically. I got the email, but it's not on my calendar anymore.

Oh man, so I didn't get it.

I didn't get a notification. I mean, I got a notification yesterday that it was going to be today, right?

Um, but I didn't get it.

Yeah, yeah, but I didn't get all the other notifications that I have usually gotten.

Oh shoot. All right, I gotta talk to Anne. We'll fix that.

So yeah, that may be why. That's why. You know what, it's been kind of screwy. Zoom has been— the Zoom invitations have been kind of screwy for me for a little while. I haven't gotten like I get the email the week before, uh, the day before, I guess.

The day before, 4 hours, and 1 hour, and then 1 hour.

But I, um, I don't know, for a while anyway, it seems—

we'll figure that out. That's important.

Yeah, it's nice to have it as a standing meeting on your calendar, right?

Yeah, yeah.

So I just had a— I just had a power failure at the house. Oh my gosh, a brief power interruption.

And, but you're back, so that's pretty quickly. It didn't take long for you to sort of—

Oh yeah, I put my internet on my phone, you know, hotspot. Okay. Yeah, rather than wait for the internet here to recycle.

Yeah, waiting for the router.

I've got everything plugged into a battery backup here, so everything can go down and I'm still alive.

Well, I'm in Memphis and we, you know, we have sort of very well-known power outages here. The XAI thing hasn't made it better, but usually it's with storms, you know. We have great—

we do the same thing in Marietta, uh, we have our own power system, but if the wind blows, like it's right now, it's blowing outside, um, we get a little surge now and then. Just part of living here.

Yeah, exactly.

Yeah, I remember that reminds me, I went to surgery in India rural India, and every time it rains, the power goes out. And so we're literally, we're literally in surgery. I was in surgery 2 days where everything just shut down and the patient's on the table. And then they did have a diesel generator, but it takes about 20 minutes to kick in and then they have to boot up the C-arm again and everything. I've never seen that before. That was crazy.

Oh my God. Well, in this day and age of computer, you know, navigated surgery, navigated orthopedic surgery, I know that's one of the things that we always were concerned about is, well, what happens if the power goes out and you lose power to your, you know, are you gonna have to re-register? Are you gonna have to redo everything with, and I'm sure computers have gotten a lot smarter or the, the programming has gotten a lot smarter and the power is, but you're totally right.

Power is, is gonna be, uh, an issue going forward cuz all these data centers and And, you know, population's growing in the US, so we just can't keep up, I think. Yeah.

Rolling back, I gotta reset my home alarm.

Uh-oh. When, um, when XAI first came to Memphis, they were doing a huge power drain on the grid, and now they've got, you know, kind of, uh, they're running diesel turbines and stuff, I think, or natural gas turbines, but, um, it, you know, we were losing power a lot and everybody's like, no, it's not because of that. It's not because of that. I'm like, it's gotta be because of that. How can it not be?

You were right. It's gotta be. Here's a, here's a bunch of topics we can talk about today. I just wrote down. And so one of our BoneChat members, Ben Holmes, you may remember him. He's got, he's got the—

Nanokon.

Nanokon. Yeah. The hip interpositional. Anyway, he just raised $4 million yesterday. That, you know, that's probably to do his seed, I mean, to do his horse study, I think.

Yeah.

So congrats, send him a congrats. He said he couldn't make it today, but then the Techomet, Orchid merger, that's kind of big news happened yesterday. Those two giant suppliers for the orthopedic industry are merging.

Tell me about that.

Yeah. So Techomet and Orchid do, they, They make a lot of stuff that orthopedic companies use. And there were two, there were the two giants and they merged. And so it's gonna be disruptive. It's, it's gonna, I think it's gonna hurt the small companies now because the Orchid Techomet's just gonna, they're just basically gonna work for the big companies only from now on, I think.

Okay. I think it's gonna hurt the big companies too, because I think unless you're Zimmer or Stryker, I'm not sure. I mean, even when we were, you know, at Smith Nephew as number 4, after all the consolidation and stuff, we had a hard time getting, because we weren't Zimmer or, you know, or Stryker or Johnson Johnson DePuy. But I think even they will suffer a little bit, but I know as number 4, so I think they're gonna hurt. I think they're going to hurt everybody with this. I don't think they're going to—

I think you're right.

And I don't think they're— I think their customer service is going to probably suffer too.

They were supplying— they're suppliers to the orthopedic industry. Yeah. Manufacturers.

Okay. And design.

And instruments and everything.

Okay. Instrument trays. Yeah. I mean, you know, Zimmer doesn't make instrument trays. They buy them, you know?

Okay.

Yeah, it's going to be disruptive. That's anyway, that was a big one. And then Smith Nephew bought Integrity Orthopedics, Sports Med shoulder company. That was a big one. They've got some kind of cuff repair that's supposed to be better. $225 million cash and then $225 million in earnouts that they'll never see. Because the big companies don't hit the milestones once they acquire. But then, and I'm trying to figure out what Integrity Orthopedics revenues were and kind of the word on the street is $20 to $30 million range, which, so that's a big multiple. And I kind of wrote about this. I think this is the age of sports medicine. And I think that, that's, that's an endorsement if somebody's willing to pay 8 or 9 times sales for sports medicine startup, essentially.

That's incredible.

Yeah, that was a big one. And then the JP Morgan—

oh, go ahead. JP Morgan is incredibly invested in the shoulder space. And I know they're, because we've had some conversations with their shoulder team, and I know that they are really trying to bridge that divide between, you know, kind of their ortho channel channel and their sports medicine channel, both strong channels. But, you know, to have products that play in both, I think, probably bodes well for them.

Yeah. Here, answer this question, Laura Lynn. I've always heard that all the power at Smith Nephew used to be in Memphis, and now it's in Massachusetts. And sort of they're calling the shots. Is that true still?

It was sort of moving back., you know, to sort of in the middle when I left. But that's been, gosh, that's been 5 years ago. So I don't really know who has the power and I don't know many of the players that are there anymore. So I don't, I don't know. It seems that orthopedics is coming back into its own. Um, you know, but the, all the glitz was on sports medicine for, you know, for all the investment was taken from ortho and put into, you know, after the ArthraCare acquisition, um, you know, kind of back in that timeframe. So that's been a while. That's, 10 years probably by now. But anyway, yeah, it was, there was a big shift. And I think it probably is more back to middle because I think maybe they figured out that they have strength together. And then if you put wound on top of that, you know, there can be a lot of synergies, but I don't, at least last I heard, I think they're still kind of siloed, siloed businesses, but I think to have products that play across both spaces You know, I know the elbow team is really trying to use the, the elbow— I'm sorry, the shoulder ortho team is trying to use the shoulder sports team synergistically to sell.

Got it.

Interesting.

Yeah, very interesting. Patrick Jamnik. The other big story is JPMorgan, and I've gotten a few notes from people that were there. Said there's a lot of— looks like investments coming back into the medtech space. There's a lot of hot stuff, you know, promise told there. Patrick, did you go to JP Morgan?

No, I haven't been for a number of years to that meeting.

Yeah, it seemed like a lot of positive stuff happening there, but we'll see. Proof is in the pudding. And then sort of the last topic I wrote down was, you know, Therese Medical just totally hit the wall. They just released earnings. Fourth quarter this year was -9% over fourth quarter last year. And their annual revenue is flat in like the low $200s. I mean, they have totally hit the wall.

They fired some people.

They have no choice. And here's the thing. So, their market cap is $175 million. They've got $100 million in assets. So, you could buy the company for $75 million. I mean, that's— I keep thinking somebody's going to swoop in and buy them, you know, offer a premium in the stock and just take them out for $200, $225 million. That's like nothing. I mean, Smith Nephew just bought Integrity or the picture for $225. You know, I, I just seems like, seems like that's got to happen, but I could be wrong.

I saw an analyst report this week. It wasn't on Trees, but, um, I read it really quickly as I was doing a number of other things, but it was a, it was an analyst report on It was on Innovus, but I, I could have swore that it said that the foot and ankle market contracted last year, which has to just be pricing pressure if you ask me. Yeah, that, um, I don't think less plates and screws were, were sold than the year before, but it's—

if—

but I could, I could definitely see like pricing pressure causing that. Um, that it said the foot— I'll try to find this, it was from a couple days ago— that said the foot and ankle market contracted last year.

That can't be procedure volumes. It's— you're right, it's got to be pricing.

Um, so in my orthotecnic business, between like 2010 to 2018, you know, we, we had Osteomed up until I guess 2020 or so, pandemic. A bunion repair using Osteomed plates and screws might have been $1,600 on the high side. When we took over Treece in '18, Um, by the time I sold it back to them, the ASP was like $4,500. Today, they came to me— they came back to us last year and asked me to pick up some crappy territory in East Tennessee and, and thing. So, you know, I gave it to Carlos, my surgical guy. Now he— when he does a bunion there, it's $9,000.

Gee whiz.

That's the ASP, $9,000. So what Treece has done through their hyper-aggressive pricing and add-ons and everything else, they took bunions from probably an ASP of $1,500, sometimes maybe even less, just a couple of screws for a chevron, and they cranked it all the way up to $12,000, $10,000. I mean, into, into what used to be shoulder territory.

Yeah, knees, knees, that's more than knees and hip.

Yeah, yeah, it says it right here. This is from a Wells Fargo analyst report, um, after a meeting with— after meetings with Inovus. Uh, it said foot and ankle showed weakness throughout the year with the market shrinking despite historical 7% annual growth rates. Inovus still grew above the market in foot and ankle, but performance was softer than in prior years. So yeah, it says with the market shrinking, it doesn't say by how much, but it says with the market shrinking.

Wow. When you say, and you think it was pricing, price, pricing.

I have to, that's my guess is that, yeah, it's, it's totally not based on anything other than I just, if, if there are people doing $10,000 bunions, it's not a big deal for someone to come in and say, we'll do this for 8.

So, right. And there's so many, there's so many product choices now. Yeah. You know, there's, there's 20, 30 bunion systems.

And what you actually sell is very undifferentiated. There's different educational offerings and stuff, but what hospitals are paying for, the screws and stuff is, is quite, you know, is relatively, you know, I, for without getting into product fights with people, it's relatively similar.

Yeah. They're, they're, I think that, so yeah, I talked to two female podiatrists in the, up in the Northeast and they said they use Treece because it brings them free patients. It's marketing. It's the only company that just brings people in the front door all day long. And they're, that's, But they said the products are kind of the same, but they'll always use Treece because they got the funnel of patients.

Well, I know starting in 2019, the distributors contributed, say, $250, $500 a month to their Google ad campaign. I didn't know that. And they would either match it or double it. Oh. And that's absolutely true. They built from the ground up a B2C. That drove patients to their champion surgeons or whoever was on their list. And that's exactly right. In fact, the Josh, the guy who does the lead gen, uh, I'm meeting with him. In fact, I gotta leave early. Uh, I gave him a business idea. I said, what we need to do is take your program of lead generation to the industry and have them split the cost with the dealers. Because what the industry needs to do for most of their distributors is, is they, they gotta feed 'em leads. They gotta, you know, lead the horse to water. Otherwise it just kind of, it's too stagnant. The, the reps are too busy in the OR. They don't make, they don't have time for sales calls.

Right.

Anyway, Josh loves the idea. We're gonna, we're gonna try it.

Yeah.

I love that idea too. Yeah, I've just, I've been talking to a lot of trauma reps. I'm doing a search and these guys, they, they don't have time to think. I mean, I was supposed to talk to a guy last night. He calls me at 10 o'clock last night saying, I'm still in surgery. You know, I can't talk. I mean, it's just, and they're just schlepping materials around, you know, they're, they're checking in trays and making sure things are clean. And I mean, they're doing quality control work. You know, it's, but trauma is especially a young man's game. It is a young man's game. It is so manually intensive.

That's 'cause none of the, none of the techs that work in surgeries these days know their ass from a hole in the ground. They don't know, they don't know the back table. They don't know the Mayo. If a rep's not there, the doctor's helpless.

Wow.

It's bad. And what's the reason? They're just hiring cheaper, less trained reps, or, or—

No, no, the reps are good. I'm talking about the, the OR tech in the OR. Really? The OR techs, uh, they're— the staff turnover.

Oh, I can see that.

Yeah, yeah.

I mean, and it's just a more generalist staff, like you're—

Yeah, that's exactly right.

You're just dealing with whatever comes in. So plenty of times it's not even orthopedic, let alone, let alone orthopedic trauma. It's just when, when the hours shrink and it gets closer to sort of third shift, it's just a, it's, it's just a much more generalist staff.

That seems sort of anti to what hospitals are sort of going towards though, right? Because for years we've been hearing about let's get the reps out, let's get the reps out, let's get the reps out. But If they're making, you know, these procedures become so rep-dependent, then that seems like that's going against kind of a trend that they've been, you know, sort of pursuing for a number of years now.

They pursue it and they should do it, but they just can't, like, they can't quite get themselves.

It's just not a coordinated plan.

I mean, yeah, you know, and also I don't think pricing is low enough yet to actually get the reps out. Like I do, I myself think like when everyone says, oh, we've been talking about replis models forever and it's never going to happen. Like, I actually do think it will happen, but I just think we're not there with the pricing yet. I think when pricing gets to a certain— there is a certain point where people just say forget, forget about it. But so far people have just been— the reps have just been taking the hits. Like, they're either dealing with the pay decreases or dealing with the increased workload to maintain the same pay. But like, basic economics says that like you'll get to a point where you just can't, like, where, um, it's just not, it's not possible, or the only people possible to put in there are really worthless because they're, they're sort of so young and so inexperienced and therefore are willing to accept pay that makes it all economically viable.

People that can carry the trays, right, back and forth.

Yeah, yeah. I, yeah, where we're going long term, I think, is the robots are going to take over. I mean, it's, we're not there yet. But did you, you see what Elon Musk said yesterday? That, um, if he were a young person, he would never go to, to medical school now because robots are gonna be doing all of the surgery. The best surgeon in the world in 5 years will be a robot. And he's got, he's working on the new Optimus 3 that just looks like a person, has incredible articulation. No, you know, can think way faster than a human. It's, and I think the robots are gonna show up down in sterilization first and then maybe the circulating nurse second and then surgeons later. But you know, they're cheap, they never complain, they show up on time, they know everything that's ever happened. I don't know.

It's, yeah, I'm not sure I'd wanna bet against Elon.

Exactly. He usually can see the future or make the future.

I'm working on a project in Atlanta. I've read an AP article in December about what happens to kids in school when their parents get evicted in public school. And there's a, there's a law called the McKinney-Vento Act that says that your school system has to make arrangements for your student to stay in that same school. So even though you are unhoused and stable, unstable from your housing, you're stable in your school environment. And I thought, I said, I said, that, that's a good idea, that's a good law. So I decided from a pro bono standpoint to see what I could do, and I found out that the problem is information access to that low working-class unhoused student. Parents. And so what I'm pitching to the Atlanta school system is they put an AI agent on their website that I will provide, and that way, you know, that AI agent can always give information 24/7 to someone getting evicted, how to keep their kid in school. But so that's just an AI story. That's the only reason I brought it up.

Wow, good for you. You have a big heart, Mark. That's— you got like 10 businesses going and you're trying to help inner city schools.

Yeah, that's great.

I thought it was just, I thought it was a good article. You know, every once in a while, as mercenary as we are, you ought to try to do something good.

Yeah, absolutely.

Patrick, what's the latest with you?

Um, not much different. I assume you're talking professionally. I mean, it's nice here, had a nice, uh, you know, nice workout this morning, but, uh, um, No, not much new. We've got some creative sort of financing that we're going through right now that we're almost on the back end of. It's very sort of messy and complicated, but at the end of the day, a good thing, I think.

So it's for the US business or for the corp back home, the corporate business?

Well, I mean, on the balance sheet, it all sort of looks the same, but like, I know where the money's actually going, and, and that's here. So, uh, good.

Yeah. And do you have, you have some new 15Ks cooking, or some cooking, I guess you could say?

Yeah, but nothing, nothing, uh, nothing, nothing through. That, that's a, that's a big sort of point of frustration of mine, and where we need to spend, um, meaningful, meaningfully more, um, is, uh, is pushing, working faster. I, I I, I, uh, I'm quite annoying with a lot of people saying our size and striker speed is not a winning combination.

So, um, um, speed is everything, man. Um, there was a leaked memo, you know, so Musk is famous for telling, you know, meeting with his people saying, what have you accomplished last week? And tell me what you're gonna accomplish this week. You know, it's like holding them accountable. Well, Bezo, there's a leaked memo from Amazon. Bezos is doing the same thing with his team, I mean, it's like, tell me what you've accomplished this week or we'll find somebody else. You know, it's, they live week by week.

Do you guys know about how Amazon runs meetings? Have you heard about this?

Tell us. No.

So, uh, I think this is very interesting and I can't get myself to do it completely, but I, I think I really personally like endorse at least the spirit of the sort of rule. If not taken to its literal conclusion. So at Amazon, when you schedule meetings, first of all, no slides are allowed. These are internal. These are internal meetings. First of all, no slides are allowed. Second of all, you have to, for the meeting participants, you have to show up to the meeting with a memo, a written memo, no less than, or no more than 6 pages in length. And you show up, no one reads it ahead of time. And the first portion of the meeting is you sort of hand out the memo and everyone sits in the room and reads it. At the same time, and then you discuss. And the idea behind it is that slides like PowerPoint basically has caused us to be sort of bad argument makers, that it's too easy to sort of throw up a handful of bullet points on a slide. And the actual act of like writing out in written form and in actual, you know, sentences and pages, typed, typed, you know, I don't mean physically written, but the actual act of writing it out makes your argument so much crisper to the point where you might even cancel the meeting because you actually realize you have sort of a half-baked or incomplete or kind of bad argument that the, that the act of writing it out makes your, like, it makes everyone, and then reading your actually like well-articulated point that you're trying to make fosters such a richer discussion that like, that's the rule apparently at Amazon. I just learned about this recently and I think it's a great idea. I don't want to get in the habit of like having to write out memos all the time, but I certainly at least in spirit like endorse the idea because I've had some half-assed arguments that I'm sure made that I can kind of like muscle through a meeting through like how you say things or the way you say things that may not actually be totally like complete. If you had to actually write your points out and make them in written form, they don't sort of stand up to scrutiny as well.

I love that idea.

Write— writing clarifies, it just crystallizes your ideas, you know.

It's—

yeah, well, that's something that I learned by accident that I later started using, is when we're having a meeting and somebody puts up a PowerPoint, I would pull the plug on the PowerPoint and make them just do it verbally. And the way I learned that was, um, I was in Phoenix In 2000, we're getting ready to make our first million-dollar sale with an orthopedic account for digital imaging. And then my competitor was there and they, we were in a restaurant. We were both basically gonna pitch side by side and they forgot their slide projector and there were slides and they broke it. So when my turn came, I couldn't show my slides.

Yeah.

So I had to do everything by word picture and just talk my way through it. And we got the deal. Wow. And I just realized that the only reason that happened was that I had rehearsed like it was a Broadway play.

Yeah.

Yeah.

Yeah.

That's what I was gonna say. I was gonna say kind of the same thing. If I think back to the big presentations that I've done, like in front of the, you know, the, the, um, at the national sales meeting in front of, you know, 700 reps or whatever, the way you prepare for that is to, for me, is to write it all out. Right? It almost becomes, all right, this is what I'm gonna say. This is what I'm gonna talk about. This is how it's going to be. And then from all of that, you sort of create your very high-level kind of presentation that goes along with it. But if you don't, if you haven't done all that other stuff and you have a power failure or you have to talk to a customer and you don't have to, you know, the luxury of all this technology to fall back, it's the way to do it, right? You still know what you're going to say. You still know and you can do it without looking at your slides, you know, at all. And so I think—

I can—

there's value to that.

I can think of numerous times being in school, college, grad school, where regard, you know, the, the teacher, the professor, they would let you bring like one page of notes to the test. So you, you spend all of your time studying, making this like insanely detailed note sheet, writing as small as you possibly can, and then you bring it to the test and you never use it because the whole— because you know, the The act of creating the sheet is the sufficient amount of studying that you need that by the time you actually show up for the test, you know the material because you spent all this time creating this note sheet and you learned everything you needed to learn in that, in that process.

Good. Yeah.

That's really good.

Tiger, I gotta run. All right. I was gonna, I'm sorry, I had to leave early today. I was, it was already, uh, something I had planned and if I'd known we were gonna have this intimate gathering, I would've changed my schedule.

No worries. No worries. See you next week.

Everybody have a great week.

We'll get the invite figured out.

Okay.

Thanks, Mark. Yeah, I learned them. I was at Soldier Orthopedics in the '90s and I had to give a big presentation and they sent us to a presentation coach. Man, I learned a lot from her. That's the most I've ever learned. She, we, you know, we had a bunch of slides and she said, okay, give me your presentation. And then she recorded it. And then she said, okay, I'm gonna play it back without sound. And she said, what is this person projecting? And she said, it's all body language. She says all communication human to human is body language. And she said, well, you know, she could turn the sound off and say, well, they're nervous or they don't believe in the slide that they're saying or they're fidgety or I mean, and it came through without any audio at all. So she said very few words, maybe one word on a slide, and look straight, never look back at the audience. Always look at the, you know, I mean, look at the audience, not the slide, and connect with the audience. You know, that's the only thing that matters. And man, I learned a lot from her. And she was coaching like CEOs and senators and stuff on how to present. She said also go out in the audience and touch people. Because they, that takes their, if you can walk through an audience while you're talk, while you're presenting, man, that they can't help but, but lock into what you're saying.

That's consistent with the, the 1960 presidential debate between Nixon and JFK. And it was the first one that was ever televised. And famously, the people who watched it on TV thought Kennedy won, and the people who only listened to it on the radio thought Nixon won. Um, and it's all about camera presence, body language, those types of things. Nixon was saying— I mean, obviously I wasn't, I wasn't alive, but Nixon was saying things compelling. He was saying— he was artic— he was like literally articulate with his, with his words, but he was looking off in random directions. He was like sweaty. He just like, you know, he just didn't look the, the, the, you know, just sort of didn't look the part.

Yeah, body— humans pick up body language like crazy, and females more than males. Females always have these secret powers that we don't have, and one of them is you can, you can read a room way easier than guys can. You probably don't know that, Laura Lynn, but you can.

Yeah, I, yeah, I do kind of know that. I think I have, I had a boss once, once upon a time, way, way, way back when, who I would say, well, you know, this person is so-and-so, and I would come to this conclusion about this person. After not a lot of interaction with the person. And I would say something or whatever. And my boss was like, no, you jump to conclusions about people. You just don't give people the chance to, you know, to really whatever. And then he came back to me a few months later and he's like, you know what? You've got something. You've got something. You're able to, you know, sort of figure it out. So yeah, there's maybe something there.

Men have a blind spot. I just saw a really funny cartoon the other day. This guy wakes up in the morning, he goes to the refrigerator, and there's a note on the refrigerator that says, "It's not working anymore. I'm leaving." And he takes the note off the refrigerator, and he opens up the refrigerator and goes, "No, it's working great." Yes, you have to be very prescriptive with your words. You do. Yeah.

Yeah.

Yeah.

I'm waiting for a, uh, for some laptop company. I'm very surprised it hasn't happened yet to put, to put the laptop's camera or a desktop, like to put the camera somehow build it right into the center of everyone's screens rather than like right, rather than right above it. Because now we're all used to doing these types of things and it's the equivalent of the three of us sitting around for a conversation, but I'm just staring at everyone's necks when I'm talking. So, um, Um, because everyone is like sort of not looking, you know, not looking at the camera like you're supposed to, but you're looking like below, you're looking at the screen because it feels like a conversation. Uh, yet you're like, according to the camera, you're staring too low. Um, so I'm— I don't— there must be some technical thing that I'm— I, I don't know computers, but there must be some technical reason that they can't do it because it seems to me like an obvious thing to just put a tiny little camera right in the center of the, of the screen. Maybe it's too distracting to do other things, but interesting.

Yeah, that's an interesting idea. And I tell you, because I've got kids that are grown, right? My kids won't be taking, you know, pictures of each other. My kids are always like, all right, remember when you're holding— when we're looking at the phone, look, you know, here, don't look just to the middle of the thing because you're not going to look like you're looking into the, you know, into the camera. They're like, make sure you look here. And I was like, okay, obviously, but it's not obvious because I have so many pictures of us where I'm like, you know, looking high or low or whatever.

Yeah, totally.

So cool. What else? What can I help you guys with? I feel like, you know, this is like intimate, like Mark said. Is there anything I can do for you, Laura-Lynn or Patrick?

No, no, we're just— for us, we're just trying to get the, you know, get our funnel, get our funnel full, you know, get our Comma Connect app in front of folks and kind of slow towards the end of the year. And, you know, hopefully things are going to pick back up with the start of the new year and new budgets and all of that. So I mean, that's, I think, for us, we did enjoy our, you know, the ability to present to the forum, to your forum.

Yeah, yeah, hopefully. And that, hopefully that video will travel. You can use it, cut it to pieces.

Yeah, yeah, for sure, for sure, for sure.

I never know who watches these things when we have a startup that presents Yeah, it's amazing how people will say a year later, hey, I saw, you know, Nanocon, you know, I learned all about Nanocon.

Yeah, yeah, yeah.

It's, well, and that's one thing I got a message. Oh, sorry, go ahead.

I was just gonna say quick fast. That's one thing I've learned about just from podcasting, from our podcasting aspect of our business is how evergreen content is. Yeah. Because, you know, after you would think that after a year people aren't gonna go back and look for, you know, OTA podcast or AOFA's podcast or whatever, but people do. People do. If they're interested in the content and interested in, you know, kind of doing the search for it, they will find. So I think there is an amount of evergreenness up to a point, you know, to digital media that surprised me.

I got— I'll share just for a second. I mean, I got this just yesterday. I forgot about this. I got this just— wait, that's not it. I got— Tiger, you'll appreciate this. I got this just yesterday. I listened to your interview with Tiger and found it interesting. Like, so, uh, yeah, it was, you know, and that was, that was, you know, that was— so yeah, it does live. These things live. They have a shelf life far longer than, than they do.

And especially, I think YouTube is amazing because of their algorithm. Um, you know, whatever you spend time on at YouTube, it shows you more, uh, more subjects like that. Yeah, yeah, yeah, yeah. It's, it's, uh, I think YouTube— and I totally agree with you, Laura Land. I, when I write articles, I try to make them evergreen content, you know, unless it's news like Takumet, you know, and Orchid merging, you know, that's, that's just news. It'll disappear in a few weeks. But things, you know, other things, I try to write it. And, and what another thing that blows me away is, I, you know, I write an article every day, right? And I've been doing it for 15 years, and people will literally— I'll do a recruiting call. Hey, I read your article on this. And I said, really? And they tell me, and they said, I just read your article. It's great. And I'm thinking, I wrote that 2 years ago. And the person doesn't know it's not fresh. It's incredible.

Well, and we have the capability to sort of reinvigorate it too, as you were saying. We can take something that's been published store, been produced or whatever. And then, you know, put it, use it, a clip of it as a, you know, on social media or use a, you know, refer back to the main thing. And I think it just makes the cycle, uh, you know, sort of live so much longer, which I think is, I think is really good. But there's also a lot of stuff out there, man. There's a lot of stuff out there. So I think that's one of the tricks I think for all of us in the entrepreneurial world is how do we create, you know, that, that voice that's going to get some resonance, you know, how do you, how do you get some share of voice? How do you, how do you get heard above all the noise, above all the cat videos and above all the, you know, the things that can be a, just a big distraction.

Yeah. I think I, I'll give you some advice that I've learned and you have to, you have to pick a very narrow niche. You know, if, if you, if you're talking about or writing about orthopedics, nobody cares. But if you're talking about a really specific thing that is in search terms, I don't know, something really specific, somebody will be on YouTube or Google searching for that and it'll pop up. But nobody searches for orthopedics. So you have to be very narrow and specific with your topic. The other thing I really believe is nobody produces enough content. So, you have to just, we get instant feedback now when we do a podcast or, you know, produce something. So, you can just do hundreds of things and see what sticks. And then when something gets traction, you do more of that. So, people don't trial and error enough. I really believe. And then the third thing is you have to be different. And that's what I hate about, you know, all these, all this company media that comes out, you know, hey, here's Dr. Johnson, we're having an interview with Dr. Johnson about our new hip system and it's got this new, you know, coating on the side and this is really exciting and it's just, oh, the lighting's perfect, it's scripted, it's just terrible and, and that's what the co— the only that the compliance department lets them do that. They won't let them just go out and do a man on the street thing, right? You know, just wing it with a cell phone. So you, you gotta be different. Different. Um, Osseo probably has some of the best content. Uh, Artelon had really good content before they got acquired. Uh, you know, Treece does some good content., but it's different. Yeah. Um, yeah.

So anyway, it hasn't gone through 9 layers of lawyers.

Yeah, exactly.

That's probably what, like, you know, or yeah, I mean, maybe that's a little too critical of the lawyers. The people who are predisposed to work at the bigger companies, especially the ones who are going to make those videos, those are not like senior positions. Those are people that are very protective of like not taking things that could be perceived as risky. Within the organization. And standing out is not always like a feature or a, like a, there's a limit to the, to like how far outside of the sort of norms a lot of people who in those, especially in those types of jobs that the really large companies will be willing to, to, to go because they're not being asked by their bosses often like let's look totally different than everybody else.

Yep.

Yeah.

So, I had a little experience. So, when COVID hit in 2020, you know, the recruiting was gone and Osseo called me up and they said, hey, we want you to help us with our marketing, you know, stuff. And so, I had a digital media friend and we, and Brennan said, I love Brennan. You guys have probably met Brennan. He said, I want you to show me some campaigns that scare me so I can't even sleep at night. He goes, I want to toss and turn in my bed all night thinking about it. And so we gave him 3 choices and he picked the hippie one. It's sort of back to nature hippie one that he picked. And then they ran with it. And their surgical training doesn't look like anybody else's. They've got like dry ice and loud music and posters and armbands. And it was, it was an, it was a, when they did their training, it was like, it was an experience. It didn't look like medicine at all. And I don't know what they do now, but I knew what they did 5 years ago. And it looks different. Back to Nature became kind of one of their things. And then they started doing man on the street. So they would, every time their marketing person was on the road, she would just go downtown and take a metal screw and an Osseo screw and just ask people in the street, do you want, would you rather put this in your body or this in your body? This one turns into bone. And that was, you know, and it was, it was like a Jay Leno, you know, thing on the street. And it, man, those things were, were powerful. And then they started getting the pediatrics, and they would say, do you want to put this in your child or this in your child? And man, nobody— you know, Smith Nephew can't do that. Zimmer can't do that. They're not allowed to, you know. So I totally agree. That's interesting.

Totally.

Tiger, as a recruiter, answer a question for me that I think I know the answer to, but I'm curious. Yours. Why don't, especially in, in, in a fair amount of sort of mid-level and higher positions within not even just orthopedics, but medical devices in general, the, the overall compensation is high enough that like, I've never understood, or I've been surprised that there aren't like, like people that act almost as like agents to get people hired. At places. There are recruiters who— but recruiters work for, for companies. Like, that— if you are, uh, like an individual, let's say, like, there's no one on the other end of the— there's no one— so, like, you don't have anyone, even if you— whether if you wanted them or not. It's like, it's like you can't go find someone to represent you on sort of the other end of the, of the, uh, train. You can find a generic lawyer and stuff, but they don't have industry expertise and those types of things. So I think I know the answer as to, like, why that has never sort of like taken off. But I'm, I'm curious to what you think.

Yeah. Yeah. So I thought about that a long time. I've talked to other recruiters. So recruiters work for companies. Yeah. And, and there's two kinds of recruiters. There's contingency and, and retained. And most people are contingency. There's like 95%. And I hate those guys because they, they're just emailing resumes all over the place.

Yeah.

Trying to get lucky. They'll take the same person and email to 10 companies. They don't care about the company. They don't care about the candidate. And then there's the 5% that have a real relationship with the company. And we spend a lot of time with candidates. And instead of just, we will give you 3, 4, 5 great hireable candidates and we'll spend a lot of time with them. So anyway, but we get paid by the company. We don't get paid by the individual. I've thought about that model. The hard part is nobody wants to pay for an agent. You know, it's like buying insurance almost. Uh, you know, okay, I wanna, I wanna raise my career, so I'm gonna pay Tiger Buford $1,000 a year to be an advocate for me and look for new jobs. Um, you know, that model has never worked. And I don't know why. You could get, if let's just say you get 100 people paying $1,000 a year and it just never works. Absolutely never works. And I don't know why. It's because people, when the people are happy, they don't need that service. And then when they get fired, all of a sudden they need it or I don't know.

Yeah. I've always thought that because recruiters are the obvious people to do it, they don't want to sever their— if you sort of, if you, if you, if you sort of, you know, sit on the other side of the table, you can never go back to working for—

Yeah, you're representing candidates.

You're totally conflicted. So therefore, like, they don't want to burn the bridges with the companies who have deeper pockets. And a person will never call and say, I need 10 jobs at the same time. But a company could call and say, I need you to fill 10 spots or 100 spots or whatever. And the pot of gold is just much larger, much larger doing like doing that. And therefore it doesn't like that's built. That's always been my assumption why it doesn't work. But like, I think, I know you're just making up numbers, but like I would totally pay $1,000 a month if I thought that someone genuinely had and like you have to show results, of course, and you gotta be coming with actual opportunities, not just this sort of like, you know, money going, you know, sort of going out the door consistently. But like, yeah, if you had enough people and then there's some extra like, and if you, and if I, if you get placed or something like that, you get whatever percentage of their recruiters, you know, no different than recruiters get from the, but from the, the companies. Because oftentimes, I think recruiters have a better sense. They have a, they have a good sense of the, the going rates for people too, like the, the, the compensation packages and stuff. And, and I think, in fact, I can think of a couple times in the past in my career where if I had someone actually advocating for me that didn't necessarily, that was willing to be a little bit more confrontational with someone because they weren't their boss. The next day, um, that they would be willing to— I think there could be 5 or 10% extra that probably could have been, like, got out of there to, you know, that, um, you know, the numbers all have to work. I, I just have never understood why it doesn't. The other thing is, like, if you do a good job placing someone, they could be there for 20 years, whereas, like, agents in other industries, they work on more— if you think of, like, media, sports, or, um, acting, those types of things, they work sort of project by project or, or in multi, you know, it's like a 2-year window and then another 2-year window. So they're always kind of like doing the next. It's more sort of deal-based rather than we could place this person, they could be here for 35 years, and then they're sort of out of that market for you forever. But I just, I've always thought that there's something there. I can't put my finger on exactly what the business is, but I feel like there's something there.

Personal agents. Yeah, I, uh, well, there are personal coaches and people pay for personal coaches, but yeah. But they don't help you. They help you with your career, but they don't help you with finding—

I always feel like that's more targeted to like get you better at your existing job, not find you a better next job.

Right. Now, there are, there are, there's this, there's a thing that a lot of recruiters do that I don't do it. It's called MPC, most placeable candidate. So a lot of people do this where they'll take a, they'll take a candidate that's really strong. And with a great resume, and they will anonymously pitch that candidate to companies.

I get those emails. Yeah, I discard them all immediately.

Yeah, exactly. And all they're trying to do is they're trying to get their foot— they're trying to get their nose under the tent and get a contract with the company. And that the most placeable candidate is just a teaser. But that— it works for some recruiters, but I think it's a sleazy way of getting a contract, you know. You know, one of the things I do is I never go out and seek business. So, I do zero sales because people just call me out of the blue because I'm, you know, I'm out there. And then, you know, a lot of the companies that call me, I've never even heard of them before. But, and they're small, they're usually pre-revenue or they're early revenue. And they just reach out to me just out of the blue, which is which is nice. Yeah, recruiting, you know, when I was a recruiter, when I was working in industry, you know, I hired a ton of people and, you know, you sort of have a love-hate relationship with recruiters, you know, but it all came to crescendo when I was at Ellipse Technologies. And I had to replace all 6 engineers. And, and I'm, I'm going, well, I know everybody in the industry, I can do this myself. So, you know, and so I had this spreadsheet. I'll never forget, I had 145 people in this spreadsheet, and I was calling them, emailing them, texting them, come out to California, I work for Lips. And, and I just, it just became, you know, 10 hours a day. And I couldn't do my regular job. And I just said, forget it. I'm going to hire one of my favorite recruiters. And it was like, why didn't I do that earlier? It was, I mean, you just put it in the budget, you know, and there's great people just coming into your email box. Yeah. So, recruiting is, I hate the word recruiter. You know, everybody, you know, tries to— a lot of people try to rename themselves, but everybody knows where the recruiter or headhunter is. So, it's a necessary evil. Every industry's got recruiters that know that industry really well, you know, and they're valuable. Good, great question though. It's like a candidate agent. The other problem with your model though, if I got 100 people that I'm working for, they're just going to wear me out. You know, do you have—

they're going to always be calling like, hey, that's a good point.

Yeah, if especially if they're paying me, it's like, hey, it's Thursday, do you have anything this Thursday? You know, um, yeah, the hilarious emails I get, Patrick, are 'Hey, this is Joe. I just got fired,' or, 'This is Joe. I'm not happy. I'm looking for my next career move. Help me find a job.' Yeah, yeah.

I don't know you. I've never— yeah, exactly. Yeah, yeah.

It's like— and I usually send a nice note back saying, 'Well, I work for companies, not candidates, but here's some advice.' Interesting. So Patrick, did you not get the invite automatically for this call? Was it, uh, Laura, Lan, and Mark said that it wasn't on your calendar like normal?

Um, it was on mine. It was, it was on mine like normal. I, I was ready to log in and my phone rang at like 1:59 Central Time.

Somehow we botched the, uh, the invite this week, but It was open to— I'm gonna fix it.

I got both of the emails, but somehow I didn't— it wasn't on my— and in fact, what's on my calendar is still the one from how to utilize LinkedIn without automation.

Oh, wow.

So that's a couple of weeks ago, right?

3 weeks ago. Yeah. 2 weeks ago. That's Mark's. Oh, that was before Bill.

Josh. Yeah. The Josh Suckerland one.

Yeah.

Interesting. Yeah. Yeah. Yeah. So, Yeah. Anyway, I had, uh, I had Bill Hunter on mine for the longest time. For the longest time, it was always Bill Hunter. And I'm like, well, when is Bill Hunter going to present actually?

Yeah, I got to fix that. I got to figure out, I got to talk to Anne and fix that. I'm trying to make it easy for everybody. I don't want to take your time, but I want it to be automatically who's up this next week, you know, open discussion or Bill Hunter or somebody. Yeah, we got some new startups in queue. Usually takes people a few weeks. Anne contacts them and, you know, tries to lock in a date and then come up with a topic. If you guys think of anybody that we should bring on, you know, throw them my way. There's so many— there are so many startups, you know, it's And I wrote about this like last year. There, there's easily 1,000 orthopedic startups that nobody's heard of.

Yeah.

Yeah. It's crazy.

It's crazy. But it's good though. It's good that there's still so much innovation, you know, that people are looking for, looking for new, new things, new ways.

One of the things that came out of JP Morgan is they said the seed money investments are going up. It used to be like $500,000. Now they're talking, you know, a lot of the, the early investors are, are giving $2 million, you know, and, uh, that's, that's really a good sign actually. The first seed amounts going way up.

Yeah, I think that, that is good for sure because costs are higher. Costs are for sure.

But I, but on the other side, costs are lower because of AI and, you know, all the business tools. You can do more with less people. You don't need an office anymore. Yeah, I'm seeing some really scrappy small startups. Yeah. Yep. Anyway, that's all I have, guys. We'll see you next week.

Absolutely.

Okay.

And Thanks, have a great week.

See ya.

Okay, good night too.

Bye.