BoneChat #128 - Scaling Ortho Startups: The Hiring Trap, Payer Data Strategy & AI Agent Disruptions

Yeah, yeah. So today, Stephen's open— it's open, uh, discussion. So if you have a question or update for the group, yeah, fire away right now. Uh, well, let's wait. We usually wait. Yeah, you know, it's like, uh, remember in college where your professor was You get— gave him 10 minutes and then you could leave.

Yeah, yeah.

So this is that one kid who went up and went and got him at 8 minutes.

Funny. The intro— hear me okay? Can you hear me okay with— without— okay, good.

Thanks for a few of the intros lately. They've been, um, fun conversations. And, and, you know, our bone chow was lightly attended, but A lot of people looked at the, at the, uh, YouTubes after.

Yeah, more people, uh, watch it after the fact. I think a lot of people watch, they either watch or listen while they're traveling. I think that's— yeah, like they treat it like a podcast.

Apologize if you see a cat jump up. It's had some cat running around.

Yeah, Tiger, I treated it like a, you know, podcast last week because I was in the middle of a bunch of stuff, but, you know, I kind of leered in from the sidelines.

Good. What are you up to, Bob, these days?

Just doing what I can to move our company forward. I'm founder of Corner Law, and thanks for the mention, by the way, in that recent article. Couple days ago. Yeah. There is, you know, the, the, the one product, Farsi, that you mentioned, the Coralock product, that's really our, our smallest SI product. Okay. That's only about 5% of what we do.

Yeah. It's, it, it's so hard to, I know I made mistakes with that article, but there, 'cause there's, I think it's listed 33 SI.

There's a, there's a bunch. But yeah, when you get, when you get some time, let's, let's, um, let's hook up and, and I can give you, you know, kind of give you the latest on, uh, where we're at with, with, uh, our different systems and— Yeah, what we're doing. Yeah, that'd be great.

Okay, Colleen's in the background. Kyle, Kyle's somewhere. There he is. Well, only thing I want to talk about today is Mirus. The Merus announcement is a mind blower. Uh, but what else? But I'll, I'll— Eric's got something, and probably Stephen's probably got an update for us. Um, any— whoever's, whoever's got a burning question or update, you know, jump in.

I can, I can kick it off there. Um, we've, um Again, thank you for, for the last time we're on BoneChat. It was pretty exciting. But since then, we've really enhanced our, our RepGPT concept even more. Better distributor search. We've now trained it on 1,000 different distributor profiles. And now there's 6 different areas of your LinkedIn profile that's now searchable on it, which is really, really exciting. So keyword search is even better. But what's even more exciting is, you know, say you are on LinkedIn and you see a distributor that you're trying to build out or Even if you're recruiting, you can just take that LinkedIn URL now and we'll do a live search and pull for contact, most recent contact info. So really, really trying to expand out each week of just making it easier to use and better search capabilities.

Yeah, just keep, just man, the most important thing you do right now, Stephen, is just listen to your customers. Yeah. Just ask them for brutal feedback every day and, and yeah. And probably if I were in your shoes, I would ask a customer to share their screen and just when they click and when they get stuck and why did you get stuck there and or record it. You know, those are so valuable.

Yeah.

You know what's fun and challenging is we've got a couple of European companies now and I gave them my cell phone number. Thanks. But it's all been fun. You know, it's really been helpful.. And when the best part is everyone's saying they're seeing value on Search One, and that's really what we set out to do, and that's really been helpful.

Yeah. I keep waiting for, I keep waiting for what's the AI play. You know, there's going to be lots of AI plays in orthopedics and spine, but you know, what are they? And you've certainly, you've found a chord already. Yeah. This, I got, I got this incredible email from Polsia, P-O-L-S-I-A. Couple weeks ago, and it's a one-person company, and they literally, they scrub you on the internet. They know everything about you and all your businesses, and they say, what do you need? We'll build it for you in one week, and it's only $49 a month to use your own CRM, your own whatever. And so I was like, wow, and the guy just nailed it based on I was like, this guy already knows me. Well, it was that, it was his agent doing it. And then I, and then I got another, uh, update a week ago. This guy's doing one person with a bunch of agents. He's doing $10 million a year in sales and he just, and he just raised $30 million. And, and his, he didn't even, his agent raised the money. He didn't do anything. I mean, his agent went out He said zero meetings, zero travel. I just raised $30 million at like a $200 million valuation. That's wild. I mean, all he's doing is just creating custom software for businesses. That's all he's doing.

I think the smaller companies are going to be the ones that set other companies up for success because you don't have to pass on a ridiculous $50,000 or $500,000 subscription and you can build a custom tool that works within that company's workflow. You know, so many times larger companies say, well, you have to adopt our workflows, but the smaller ones can adopt to your workflows. And I think that's, that's a key differentiator, not just for us, but for any small company like you just mentioned. You've got to figure out where the pain points are for your customers. And now there's no excuse to not build within their workflows.

Right. It's the analogy is I've heard people talk about Salesforce is awesome, but it doesn't customize to your needs. You have to, you have to fit your business into Salesforce. Well, now it's just flipped on its head where these AIs will build something exactly for you only. It's incredible.

Yeah. It's also interesting to see also the, the lack of adoption still in AI uses, or there's a lot of AI slop products coming out now. So you've gotta be a little bit hesitant of what you, you adopt as well.

So I think the small businesses are where you, you'll find the most traction, you know, Stephen. Yeah, definitely. Oh, here comes Patrick. Thanks for the, uh, update.

Yeah, thank— thanks for giving us the platform.

Yeah, yeah. Oh, Bob or Eric, jump in.

Bob, go ahead.

Well, you know, I'm kind of new here. I, I got invited a couple of weeks ago and, uh, you know, enjoyed talking about the, the, uh, the NAS Opportunity, and then followed by the Hansel tracking stuff that I listened into last week. So this is my third week listening in, and so, you know, relative newcomer, but it's great to be able to hear ideas from, you know, from other guys that are out there, you know, in the trenches trying to make things happen. So just very glad to be here for that.

Do you have any, you have any burning needs or questions?

We've been, well, we've been, we've been working on raising money. You know, we're, we're a smaller SI joint fusion company. You know, and we have reached the, that $10 million mark, but that's a little too small for some investors. You know, they're looking for someone that's at, you know, $30 or, or more. And so, so, so we're working on that. We've got a, handful of projects that we want to get going on, but we're waiting for that, that fuel to make it happen. And so, so, you know, that's where we are right now. Hey, but we're, you know, we're doing, I think we're doing a lot of the right things that can be a little bit expensive. And so we got to limit our projects until we get the other money. And we're doing clinical data. We have a clinical trial that we're doing. We've published already the 6-month data on our lateral oblique SI screw system. We published that in Pain Physician in December and great results there. And we'll have our 12-month data wrapped up by the end of July and hope to be able to get that published by the end of this year.

So what— so I'm, I have strong opinions on clinical data. Is the clinical data for regulatory purposes or committees or surgeon adoption? What's it for?

It's for a number of things. Not, you know, it's not for the FDA. I mean, we already have a 510 and whatnot. But, you know, VAT committees, it does help convince sometimes in those situations. But really, it's for coverage at this point, you know, with payers.

Got it.

That's— as you mentioned in your article, yesterday or the day before. There, there's a lot of players in this, in this market and 99% of them don't have any data. Well, not 99%, 90%. There's a couple of us that have data. And so I think that's, that's who the payers are gonna be comfortable with justifying and they're gonna try to limit others who don't have data. So I'd say that's probably the biggest, you know, and the, the physicians like to see that you are dedicated to gathering data and, but that's, that's really not the end-all be-all for them. They want to know that it's effective, of course, but they also want things like ease of use. You know, and makes sense. It's got to make sense for them.

So they want a wide patient population and they want to be able to do procedures faster.

I mean, they, right. Yeah.

Yeah.

Interesting. So, and we've, we've been able to accomplish that. Our system is extremely simple, extremely safe. Our, our clinical results through, through the study in terms of, of safety and, you know, absence of adverse events is, is stellar. So good. We're able to answer those questions well, I think, with, with our data.

Stephen.

Bob, just, I heard your fundraising needs. Just gave you a free month on our investor platform. You can search for any investor globally, uh, and contact our— about 1,500 on there. So it's good to do a little research on there. There's new angel firms specifically that pop up every week that we add on. So about 120 that we're adding this week. So I just wanted to give you 30 days on that one to play around with.

This, this invite code that you posted up there on the comments?

Yeah, perfect. Backin.ai, it's like a matchmaking matchmaking for med tech companies and investors. Yep. It's a, it's like a dating app.

And if you wanna run due diligence on your competitors, you can see what they've raised and what their clinical due diligence looks like as well. So it'll allow you to build a full report out on that.

Oh, cool. Oh, thank you so much.

You're welcome.

Yeah, you missed Stephen was on maybe 4 or 5 weeks ago. I, I've forgotten now, but yeah. It's, and his, his platforms just get better every week because it's, there's more users, there's more, there's more companies in the system, there's more reps, there's more everything.

We just don't see it. Do you record these for later playback? Is that something you go, go and watch?

Yeah, absolutely.

Yeah. That episode.

Yeah. So I, there's two ways. We either, if it's a public discussion, we, I just record it and put it on YouTube and sometimes we, we go dark. If there's like, we've had people that wanted a review of their company deck for raising money. And yes, yes, there's some sensitive stuff in there, or sometimes you want to talk about a competitor or patents. So we can just— I can, I can just hit the switch anytime and we can go dark. So that's always available.

Okay.

And Bob, I'm happy to give you a walkthrough of any of them if need be.

I appreciate that.

Thank you. So Steve, you don't mind if I, uh, use that as well, do you?

No, go for this. For everybody on the call, go for it.

Good. I just didn't want to surprise you.

No, go for it. Thank you.

Also, don't, don't, don't hog up my, my discount code.

Um, if you guys need early adopter physicians, you get anyone that signs up on this one too, there's— it gives you free 3 days as well. So play around with that one as well if you need to.

Great, great, great.

Well, Tiger, the, the, uh, question I had, um, we, we've talked on here previously about what meetings are worthwhile anymore, which are good and which aren't. And, you know, um, I have a question on one that's coming up, um, and, and you guys know I work for a small startup that has a cervical disc. We, we're selling in several countries in Europe and South America, and we have IDE going on in the US, um, that, that really has just started. So I'm trying to figure out what meetings are worth going to since, you know, I can't really advertise in the US. And, you know, so I don't know how important it is to keep our name out there right now, um, But the meeting that's coming up is, is the Seattle Science Foundation one that they put on every year. It's, uh, Advances in Motion Preservation of the Spine. And they have small booths, you know, tabletop booths. Um, but they also have a good hands-on, you know, didactic sessions, I guess. Um, that Jens Chapman and, and, uh, Dr. Ziegler from TBI are, are going to do. So I'm trying to figure out whether it's worth going to, and, you know, which ones might be worth going to if this one isn't, um, or, or should I be doing that at all based on where we are right now?

I think you got to start with the, you know, what is your— what's the goal of the meeting? Do you want exposure? Do you want leads? Do you want to meet, find distributors? Do you want to, you know, whatever? And you got to sort of start from that premise Well, and that's the part that's actually not really well defined for me, I guess.

I would say it's just keeping our name out there. You know, our marketing goes to, you know, European and South America. But, you know, I don't need to market in the US. But it'd be nice that people keep track of us and, you know, maybe an investor, you know, see us at one of these things or something.

I don't know, I would— I'd probably take the money. I mean, what's, what's it going to cost, $2,000 or $3,000 probably to—

yeah, I think, I think for this one it's like $4K.

$4K. I'd probably put that in social media and just blast South America and Europe with that. You can, you could do a lot of postings for $4,000, or start a newsletter, or, you know, start a Spanish newsletter. I mean, I would The— there's— I don't know. I, I, you know, what are your thoughts, Kyle? Kyle, you're, you're, you're smart at this stuff.

You're, you're in the business of trying to land doctors that use your product, right?

Well, not, not so much in the US because we're We're just starting an IDE trial and we have, we have plenty of doctors who wanna, wanna join that. Most of our marketing type stuff is, is European or South American. So that, that's, that's why I'm wondering, hey, are these US meetings even, even these nice, you know, intimate ones like this that are nice and small, you get to, you get to really talk to surgeons on it, whether that's worthwhile or not?

I haven't heard of a whole lot of good reasons to be at these meetings from an industry perspective in a while.

That's why I asked the question.

Yeah, I mean, they cost money. Yeah, I mean, you can, you can make connections, you can build relationships, you might find some leads, but it's lightning, lightning striking when you, when you do, I think, largely. There's probably an element of presence of mind that needs to be thought through depending on your size and position. But for startups, man, it's— I guess let's put it this way, that the couple times that I've been to Academy as an example, when I'm not part of a gigantic company that's just sending, you know, armies of people, it's been with an extremely detailed plan of why to go. Exact appointments, exact targets, pre-planning of who, you know, um, warm introductions, all of that, to where it was crystal clear. I've got 8 appointments that are going to happen that are confirmed. Sure, that justifies $1,000 on flights and hotels, and it justifies a couple thousand dollars on our tickets. Let's give it a shot. That's the best I got.

Yeah, I like that.

Second that for sure.

Yeah, that was my, my thinking as well. But you know, just like the rest of you guys, I, yeah, grew up going to these meetings, not really questioning whether it's worth it or not. Yeah, now I have to question those things.

Yeah, we're very active, uh, Eric, in, in going to meetings. We go to at least one a month, um, in the interventional space, interventional pain space. And then we also are in spine and ortho space as well. So we go to NASS and IPSAS. And so they cost a lot of money. We almost kind of have to be there, you know, with our company because, you know, for my competitors that aren't there, you know, everyone wonders, oh, well, you know, why aren't they here? You know? Are they, are they out of business that they can't afford to come to meetings? That kind of thing. So, so we try to make the most of it, try to be efficient, you know, with how many people we have attend. And it's not, you know, like I think Kyle said, it's not just the cost of, of the booth or, you know, a tag to go in without a booth, you know, it's air flights and hotel and, you know, and then if you want to dine any doctors and all that. So it's that adds up pretty, pretty quickly. But, uh, and so we try, you know, if we can get 3 solid leads at a meeting, it pays for it. And so, uh, we, we feel like we kind of have to be at certain ones, and there's certain ones where we've attended, uh, and, you know, it's kind of a loser for us. Uh, Science, uh, Seattle Science Foundation, uh, we've been to, I think, 4 of those. Couple have been great and a couple have been dogs for us. So I, I can't recommend, you know, I can't recommend for or against on that one.

Yeah, well, that all makes sense. I mean, that, that's in line with, you know, the doubts I had in my own mind. Um, yeah, and, and like Kyle was saying, the ones that we've been to, you know, we, we go to NAS each year, but it's because we have a full agenda of meetings. It's not there to be at NASA, it's because everyone's there at the same time, right? Um, okay, cool. No, I, I appreciate—

let me finish up by saying you should probably reach out to Mark Maloney. He uses an incredibly efficient, uh, social media group out of Ukraine that'll just— they'll do targeted postings for you for like $1,000 a month. You could get 4 months worth of South American, European content for going to one meeting in Seattle. Yeah. Talk to Maloney. Talk to Maloney about that group.

Eric, I'm not familiar with your, your product. So forgive me for that. Is it, is it, it's a spine mobility product?

Yeah. It's, it's a cervical disc. And, and the, I guess the, the, the, the, innovative part of it, it's made out of man-made diamond such that, okay, there's, there's no wear debris whatsoever.

So that's, you know, what's the name of your company? Is it Omnicron or something?

Dimecron. Dimecron. I'm putting the, I'll put the URL in the chat, Bob.

Yeah.

Oh, oh, thank you.

Yeah, I think it's working really well. So, you know, we're, we're really hopeful, but we just started our IDE too, but we don't, we don't have money to expand it much yet.

So yeah. So with that material, you need to do an IDE to satisfy the FDA cuz it hasn't been used, that material.

Oh yeah. The cervical discs all, all need, all need an IDE.

Okay.

Yeah.

Great.

All right, Kyle, and then Steven.

So, Tiger, you can punt this if you want, if you'd rather save this for another time or for the end, but I was curious on the recruiting and placement front, have you noticed any trend changes or any momentum swings or anything noteworthy that, that are giving you an indication of something being different?

Yes, um, the, the, the macro trend is It's because of the difficulty in funding. People are delaying hiring, and if that's just across the board, everybody's delaying hiring. And I think it's because of interest rates and raising money and trying to do more with less people. The second thing is if a small company is commercial already, they are investing in sales only. I see that all the time. I mean, I get calls, hey, we're trying to, you know, we're trying to, we're trying to span the country now. We need regionals and, you know, we don't need another engineer. We don't need another quality person. We don't need another marketing person. It's all about sales. So those are the two trends that I see, delayed hiring and increased sales hiring for commercially commercial companies.

And what about— is, is there a, a different trend for pre-commercial?

Pre-commercial is just, they're just doing with whatever, whoever they have, you know. It's, you know, money— it not only is fundraising hard, but it's not— there's no certainty, you know. It's, you don't know if, if, or you may have a short runway and you don't know if you're ever going to get money again. And so, they're just not hiring or they're hiring some consultants, some 1099s that you can quickly get rid of. They're more fractional. There's more fractional hirings. I see C-level and marketing hires and come in for 6 months or 12 months for a fixed price and then they disappear. I've seen that.

How does that work? Like, does that seem to be a worthwhile, valuable thing on both— in both directions?

Yeah, I mean, man, you got me, you got me going now. So I think the— I think the company of the companies of the future in med tech and ortho and spine are people will come together 5 or 10 people that don't even know each other will come together. They'll build a product and then they, once the product is, goes to the FDA and there's a sales force where they just disappear, you know, the peop— they'll come together, do a lot of good work and then disappear again. I think everybody's gonna be a free agent in the future. I think everybody's gonna be a 1099 and you'll join a company maybe for 6 months, 2 years, 3 years, do your thing. You'll get some equity, you'll knock out milestones, and you'll just, you'll go somewhere else. But I don't think— I just see that's the future. It's definitely a future in tech, and it's going to come to devices. What do you think, Bob?

Yeah, so you just come in as a 1099 and share your knowledge and trade it for some equity and whatever. Yeah, I, I have seen that and I, I think that could be a trend.

Uh, I think you're right about that because I mean, the reality, Kyle, you know, if you like, say you need a go-to-market plan and you need a really sophisticated marketing person, well, they come in, they build, they'll build your go-to-marketing plan 9 months before launch, and then you don't really need them anymore, you know. And the, you know, and, or your regulatory person comes in, regulatory person gets you through tough times, you know, with the FDA and then they disappear. Quality or clinical, you know, you need a clinical design study person.

Yeah.

And then you need a, you need a clinical data collection person and then you need a statistician on the back end. Those are 3 different people.

Keep going. Yeah. You don't need to stop there. Right. That applies to quality engineers. You don't need 'em at phase 0. You need them as you're moving from Phase 2 into Phase 3 and prepping for launch. Afterwards, they need to be on to the next project because they've done their part.

Totally agree.

Project managers, project leads, you need them from inception to the point of it's past the FDA and then let it move into production. What, however, the, the trick will be is there's got to be glue that puts all those pieces together and knows that they're doing it right. And that means that the company has to have that as a part of continuity, doesn't it?

Yeah, the CEO, the company, these organizations are flat. So, everybody reports to the CEO or maybe a couple of VPs and, you know, that's it. No, you're totally right. I mean, I, you know, think back of when we all used to drive to a building and sit there every day and it's like, You know, I remember walking around Smith and Nephew in the— in the '90s, like I was there in the late '80s, and we had this saying that you could fire a third of the people and nothing would change. Nobody would even know they're gone, you know?

Yeah, yeah. I, I don't have an engineering department. Um, I do, I do a lot of the design work myself, uh, and then I work with engineers. I outsource this to the guys over at Spytrex. I don't know if any of you guys do any work with them. They do, and they do our 3D printing of our titanium, uh, implants. Um, but you know, there's no reason for me to have engineers, uh, 2 or 3 engineers that I'm paying, uh, a, a salary to. We finish this project up and then, okay, now I gotta find something for them to do. Um, there's no reason for that. And so, yeah. I outsource that.

Perfect. Perfect example. That's a, that's a great example. The, the other thing that I see people make mistakes is they hire a consultant based on hours. And I would, I'd like to see companies hire based on milestones.

So, yeah.

Yeah.

You, you give an engineer, okay, I need the design or I need to pass this mechanical test by this. And you, you literally pay them for the milestone. If they get it done early, you pay them more. If they get it, get it done later, you pay them less.

Yeah.

What about any lookouts for, say you've got a go-to-market strategist that just has always worked at like a Striker, so they know like this is the Striker solution and they're trying to come and break into that early stage world and any lookouts there while you're trying to vet your go-to-market consultants on that?

Well, I mean, I'm biased, but if you've been at Striker for a long time, you're completely useless. I mean, you are, you are, you are dead weight because you only know their system. You don't know how startups are, are hard, you know?

Yeah.

And you gotta wear a lot more hats and there's no resources, you know, startups are hard. Yeah. Stryker. Yeah. People from Stryker, Zimmer, Smith Nephew, if you've been there 10 years, 20 years, you are completely useless.

Yeah.

You just see so many of them right now, especially when you kind of look around the, the medtech incubator radar program. You're like, wait, each one of these people was judge, but they've all been at Smith Nephew or Stryker or J&J for the past 15 years. And well, what hat have you worn other than just the marketing head? You know, you haven't been in the trenches anytime recently with limited budget. So yeah, yeah, curious.

Hey Steve, I don't know if— can you hear me or—

yeah, we can hear you, Pat.

Sorry, Pat here. Yeah, so, um, I, it's just echoing Tiger's view. Um, I run Field Orthopedics and Probably the worst hires I've made, and I continue to do that, just had another one just from big corporate, and they tell you all the right things, how excited they are, they fantasize about being in a startup, right? How it's going to be fun, how it's going to be, you know, value creation, equity, blah blah blah, all that stuff, and then they're 3 months in the job and they just cannot keep up with the pace. They just can't. And then it's really hard to coach as well because it's almost impossible to coach, right? So it is. And I find it super, super difficult to hire for as well. Like, you know, it's very hard to find, ask the right question and filter out, you know, who's really, who has the DNA. And, and, you know, as Tiger said rightfully, right, a startup is hard. And every time you think you're there, another, you got another headwind that you didn't expect and you just got to pivot. And, and it's just, yeah, it's not everybody's cup of tea. I find that, that, that is really hard. And it's at all levels— regional sales manager level, um, marketing level, VP marketing level, um, you know, clinical evidence generation. It's, it's, it's actually, it's, it's a— and unfortunately we're in this phase now where, you know, we're trying to scale And it actually becomes a huge risk because I don't have 2 rounds of opportunities to hire people, right? Yeah, if I go wrong, you know, with 1 or 2 people, I pretty much lose half the year, if not a full year. Yeah, so it's something that I continue to underestimate, to be honest. I find that one of the hardest. I thought I have seen it all after 4 years now. It's just another level of of, damn, how did I not see this, right? So that's just my two cents too, Steve. So, and I would definitely— just because somebody was a VP at Stryker or Johnson Johnson, um, that, that kind of means nothing, to be honest.

So yeah, yeah, I appreciate the insight.

Thank you.

Good luck on yours.

Yeah, so one, one thing I, I guess I want to add is I suppose it is possible to find some people that could come in and be rock stars in the startup world out of the big companies, but it's going to be hidden in the corner, right? It's not going to be someone that's some director of hips at Zimmer Biomet and has been there for 27 years. It's going to be someone that is in the customs department for the past 4 years that was a college athlete that just has this moxie about them in spite of having been in big ortho. But if you're, if you're trying to grab you know, senior marketing manager that's been at J&J for 22 years and they've just, that's all they've ever known, man, the moment you show them something that just has a slightly different wording to it, it's hard to adapt. And it's not a character flaw, that's just an experience difference.

So Kyle, I came out of J&J Smith Nephew, Abbott world. So I was there 15, 20 years, right? Probably 10 years too early. So yes, it can work, right? But I have to say, the last 5 years has been a huge journey about myself as well, learning, you know, the word stamina and resilience has been redefined for me, right? So, you know, so it's okay, right? So it's possible. But then I don't think everybody's gonna be as crazy as I am, right? So, and that's just a kind of call that out because it is a little bit crazy, right? You're leaving behind,, you know, the kind of the comfort zone. So absolutely it can work, right? So right now I, we've just looked at hiring 2 more regionals and I just said unless you've, you must have had some kind of exit experience or come from a company that has gone through the, you know, through the motions of scaling a business. So that those were my 2 criteria. So, and I, I found two people that did that, right? So, um, otherwise it's impossible. Yeah, I just don't have time and yeah, and the luxury to get it wrong.

Yeah, the, the fundamental thing that I've seen looking at this for decades is the big companies breed out entrepreneurs. They don't want them there. So the, they, if there's a, if there's a nail sticking up, they, they, they're, they get hammered down. They, they either get put in a closet somewhere or they get fired. And in a startup, it's the opposite. You want the entrepreneurs, you want the people that are taking chances, they're scrappy, they hustle, they don't need a lot of resources. So, it's just like Mars and Venus, it's so different.

So, I just made that mistake bigly. I mean, I overachieved at that mistake. Recently, um, and the resume was perfect, all, all of that, um, but the personality wasn't there. I mean, and I don't know how to find that though. I don't know, I don't know what I did wrong. So is there something that, that, that you guys do to, other than making sure they're from a startup?

Yeah, so the litmus test I do, Eric, is I tell them to go back to their childhood. Tell me how you grew up. You know, what I want to see is somebody that had struggles. You know, I want to see somebody that paid their way through college, worked through college. I want to see somebody that started a business when they were a teenager. You know, whatever it was, mowing lawns or anything. That's what I want to see. And you can find it. You got to find the entrepreneurial pilot light in the person somehow. It's, yeah, don't look at the resume, just throw it out. Give them problems to solve. That's another thing. Give them assignments. Say, you know, I'm not going to interview you, but here, you know, give me your best shot at this assignment. And if they're not willing to do that, like most people will self-eliminate because they don't want to do a lot of work just to earn an interview.

Question on navigating those early— like, we're, we're 4 people in our company and we have people approaching us all the time for consulting work, trying to navigate to try to get some type of equity play out of it, which we've been really hesitant to do at all. We'd rather pay them maybe on like a cash compensation or even like compensation via equity, best of certain milestones. How do you go about properly navigating those conversations? Everyone will say, well, I have the network, I had this, I have that. But when it comes down to it, it's, you know, it's— we're technology play, we're no longer device, and everyone that's talking to us is in the device space. Very different cell, very different conversations. A lot of them don't pan out.

Yeah, you're talking about consultants, right?

Yep.

Yeah, just pay— always pay consultants on milestones. Don't pay them for their time. You end up with— it's like attorneys, you know, they, they, they're billing you by the hour. They don't really care. They're not trying to solve your problem. They're just trying to earn more hours. Yeah. So, um, yeah, give them a— pay them per milestone. Yeah, that's, that's, that's how you, you separate the good consultants from the bad ones, in my opinion.

But yeah, and if you can make that person a consultant and not an employee, you know, if you hire them as an employee, you're kind of stuck with them until you go through a process of, you know, eliminating them if they don't work out. And whether or not they have performed yet, you got to pay them. And if you've used a recruiter, you know, you've got the expense of the hire to to overcome, plus training and all that stuff. You know, we have a hybrid sales force, so we have some employee reps and also some distributors. And the distributor model actually works really well for us because we don't have to pay them until they actually sell something. And so that works really well. You know, if I hire, if I actually hire an employee rep, I've gotta be darn sure they're gonna put some sales on the table and more than pay for their salary. Otherwise, I've wasted a whole lot of time and money and energy training them. So I think sometimes a consultant situation with milestones, like Tiger said, you know, you're not stuck with, you know, having to pay salary and benefits for someone that's not gonna perform.

So, let me tell you the Ellipse story because when I went to Ellipse in 2012, it was, they did everything differently. And most of the things they did worked. And one of the things they did was everybody came into the company as a consultant. The CEO, Ed Roschak, came in as a consultant. All the VPs, I came in as a Vice President of R&D as a consultant. And we, it was like a 3, 1 to 3 months dating, you know, basically. And what it did was the company was so hard, it was so fast moving that they realized most people couldn't hang at the company. And so it was, it was a try before you buy strategy and it really worked. The people that made it end up being great employees and leaders and, and, but a lot of people I mean, I'll never forget, we hired a director of quality as a consultant. He got us through the first FDA audit. The day after we got through the audit, he resigned. He said, I can't keep up this pace, you know, good luck guys. He goes, I can't do this.

It's not for everybody.

No, no, it's not for everybody.

Yeah. I mean, I, I, I worked, I worked, uh, in the '90s for Biomet. You know, in the early 2000s for, yeah, and in the early 2000s for Johnson Johnson with the Puspine. And the big corporate thing just wasn't for me. I just, I didn't quite fit. You know, I was the round peg in the square hole or, you know, whatever. Not that I did a poor job or anything. I was successful, but just some of the corporate, you know, big corporate nonsense. It was hard for me to work with. And so, uh, kind of by, by, uh, necessity, I had to become an entrepreneur. And I was entrepreneurial, like you said, even as a teenager, you know. I said, I set up, you know, lawn accounts and snow shoveling accounts, but I grew up in northern Minnesota. And, uh, you know, I had customers and this and that. I mean, you just either you have that desire or you don't. And so, you know, if you, if you're gonna, if you're gonna start a business, start, and especially a medical device business, which has a lot of moving parts and, you know, a lot of regulatory, you know, overburden that you've gotta bear with and deal with, plus coding to get reimbursed, you know, reimbursement and, and actually get paid and, and all of those things. I mean, there's just so many different moving parts and you have to be willing to wear a lot of different hats until, until you can hire someone to take a hat.

So at what point do you hire someone to take one of those hats away? You know, I'm so into ours. I'm like, do I need to hire someone? Or can I stay up for 20 hours straight and just get the coding done?

Right? Because no one can do it like you can, Stephen.

Or it's, there's more smarter than the craziness of the speed of saying this has to be done by tomorrow. We're gonna get it done. And we're gonna figure it out. I guess that's the question. I always come back to at what point do you take that away from yourself?

Yeah. When you, when you, when your hair starts to turn white, you know, or, you know, or you can't sleep, you know, you've just gotta, you gotta, you gotta look out for yourself and take care of your health. You know, and if you're married or have kids, you gotta take care of your family. So if you're eating into those things, you've gotta bring someone alongside that you can trust and, and, to offload some of those things. And, and that's hard for me to delegate, you know, because I like to do things my way. But, uh, you know, so that's been a big part of my growing up over the years and I still haven't grown up yet. But, um, you know, it's, it's being able to hand stuff off to people and say, okay, however you're doing it is, is gonna be good enough, you know? Yeah. Um, cause you gotta do it.

Some thoughts here, right? It's interesting. So we pivoted from an A series to B series, right? And we're trying to scale our business from, you know, what is $8 to $10 million to now $30 million. And, you know, you were also dealing with, you know, one of the best VC firms in the US. And, you know, what I thought I could just do myself and carry, it's not working., right? So, so this whole notion of you can do it yourself and just, just, just because you can do it yourself and it worked because it worked the last 3 years, that hypothesis has crashed on me big time.

Yeah.

So, so any, and again, I'm, and it's not a, it's not, you know, I'm not, it took me 3 months to figure this out very quickly, right? But it, you know, I'm, I'm, you know, learning, learning on the go here as well. So this whole notion of you can do it yourself is— be careful there, um, particularly when you scale. I think it's easy when you're pre-market, your first year on the market, you validating your product-market fit, you're getting your first revenue, right? Then you're sort of planning for the next step. But we're now at a stage where— and, and I can actually appreciate why so many companies disappear, um, because they cannot make that that, um, that transition from, you know, 4 or 5 million to suddenly 15, 20, 30, because that scaling is hard, man. And then you, you rely on good people because you suddenly realize you can't be everywhere all the time. And so I don't know if this is a comment or the question, maybe Tiger can, uh, give me some wisdom here. But, um, man, it is, and I'm not surprised why so many companies just, just disappear when they go into B series. It's only— they suddenly are in a dead end, right? Because they feel like they need to scale, they need to hire all these people, but maybe they overhire. But then you do need to hire. So where is that balance? You know, we're playing with a lot of like sort of OPEX sales ratios right now, benchmarking us against other, other organizations, what that journey looks like over 3 or 4 years, right? Um, But yeah, it's a whole new chapter now. It's interesting, very interesting.

Yeah, there's a— I forgot who said it, there's a rule of threes. So, every time your company grows by 3x and that could be employees like 3 to 10 employees, 10 to 30 employees, or it could be revenue, you have to reevaluate all your systems every 3x. 'Cause it just, things that used to work don't work anymore. And yeah, that's, I forgot who wrote that, but it was a startup book. But I really think that's, the rule of threes is kind of interesting. The other thing is there's three seasons in a startup. There's, you know, the founder invention, season. And then there's the getting it to market, making sure you have the right product. And there's, once you've got everything, and then there's the scaling and, uh, where you just pour more fuel onto the fire, cuz you know what you're doing. Um, so you're, Patrick's probably in the second season right now where the products work, you got a pipeline, and we're just trying to build systems for the first time to, to scale.

Yeah, that's, that's fair. So yeah, definitely, we're definitely in systems, but it's still, you know, you can't just be working on systems. You also gotta be still in the ground, right? So, and, and it's finding, it's finding that balance, um, at, at a speed that you expect as a startup, right? You want everything happening overnight. Um, so, so definitely there is, and, and then you have new, new shareholders, you have new expectations, they expect, uh, they expect the growth to be at the same pace that, that, you know, when they invested into. And, and I find the transition— so, so if I would have my way again, I would definitely forecast my revenue a little bit slower and flatter. So almost like a little bit of a flat to dip to then, to then scale again, because that transition, you need, you just need, you need 6 months to get the team right, to get the processes right, and to get the velocity and the flywheel right. You know, even somebody spoke earlier about evidence generation, and it is number— I think it's number 2 or 3 on the to-do list for my VC. Like, you need to have evidence, and it's for all of the above. I think you guys spoke about VACs, you talked about reimbursement, but it's even for future exits, right? They refer to it as future currency. So if you don't have clinical evidence, eventually it's going to be meaningless to a Stryker or a Smith Nephew when the day comes where they're trying to acquire you. So there's a lot to do there. It's exciting, right? But yeah, then you bring on new people and they do your head in because they just don't get it. Right? And, um, yeah, it's, it's, uh, it's exciting, uh, times here, um, at Feel Orthopedics. Definitely, uh, just, just when I thought I had it all figured out, cashed up and ready to go, just like, what the hell, just getting punched in the face again, just like a couple years ago where we turned it around, figured it out, right? But yeah, um, you know, we'll win, but, uh, yeah, it takes time. It's just crazy.

Yeah, Patrick, going back to your question about— sorry, someone's just texting me here. You know, it's kind of a chicken and egg thing on the timing. You know, sometimes you've got to hire somebody before you have the revenue so that you can get the revenue to hire somebody, you know, so it's kind of a circular situation, but, you know, and when is the time that you can pass a hat off? You know, I try to look at, you know, if I'm starting to deal with an, you know, in orthopedics, and I don't know exactly what your product profile is, but, you know, there's always urgent stuff that pops up and you can't let the urgent stuff eat up your time. You need to have people to handle the urgent stuff so you can handle the important stuff. You know, that's kind of that, that, you know, Franklin Planner ideology.

Stephen Covey.

Yeah. Covey. Yeah. So, you know, once enough urgent things are popping up on a daily basis, you've got to have somebody to take care of that stuff and delegate that stuff away from you so you can focus on the important stuff and, and, you know, lay those, those bricks every day. That need to be laid to build what you're building.

Focus. You're sort of swerving into focus. I think focus is what makes great startups. They just— and lack of focus is what kills companies. Yeah, you got to— you can't be distracted by all the noise. At Ellipse, we had a— it was, you know, go back to Ellipse again. We basically had a list of 30 projects and the CEO would basically every couple of weeks would say, Okay, here's the top 3 projects. You have to work on these top 3 projects. If anybody's working below the line on number 3, you're fired. And it was, it was really that. And, you know, and it really clarified things, you know. Uh, then we would knock off 1, 2, or 3, and then we'd add something to the list. But that, that focus, focus is so important.

Patrick.

Up on your website right now, sorry to kind of— this Gripplasty is well marketed. I mean, well, this is phenomenal stuff. What is the— is this direct sales, 1099, kind of what is the mark— go market on here? Sorry to derail any of that.

Yeah, we— so we're— yeah, so we— our focus is, uh, uh, building a premier hand, um, hand, uh, orthopedic hand organization. So, um, probably one of the last frontiers that has been neglected, right? Um, we I tell people we are where foot and ankle was 10 years ago. Nobody cared and now look at it today. So, so we, interesting how you said about Tiger Buford, refocus, right? So for us, we probably got ahead of ourselves in some areas. So I'm just right down back to, to the key areas that I know will be attractive from a, from a white space point of view, which, which are the strategic gaps of if the big ortho companies, right? It's leader in finger fractures. So we have a whole ecosystem and that's both on, you know, on the material side and the design side. And then all things finger and hand arthritis, that's where Gripplasty fits in. And it's now addressing, which again, we didn't anticipate that there's a little bit of pivot towards or it's not a pivot, it's a move where maybe for the first time an actual like arthroplasty is being accepted by hand surgeons. So we will always play a relevant role with suspensionplasty, gripplasty, but maybe there is what used to be 1%, maybe will become 20% of the market in an arthroplasty. So there is a product that made its way into the market, which is like a mini hip in the hand. It's a whole separate conversation.

I think it's very medical, right? What's that? That's Kerry Medical, right, with Mid-Artis?

That's right. And I hope nobody—

I don't know who, uh, no, I just, I just know that a dual mobility thumb sounds like a terrible idea. That's what I know.

I'll give you, I'll give you the, I'll give you the sophisticated way to, to beg it. It's, it's kinematically conflicted. So anyway, so yeah, so, so anyway, so we, so we're working on something else that will will make more sense, but I'll leave it at that. So just focusing on that, there is some opportunity within the PIP. Again, you know, we're looking at, you know, silicon implants that are 30 years old. So, and then all things soft tissue, right? So those are kind of the 3 areas we just focus on to give you a long-winded answer on, you know, but griplasty, and the NX Nail are the two flagship products that got us to a point where, where we created enough interest for a VC firm, right? And use that as a vehicle to build this portfolio. It is now just the art of building the right products with the right team at the right pace, right? So that we see revenue, you know, by the time we hopefully exit within, let's say, 3 to 5 years, right? So this is, this is sort of the, the fun part, right? And we've been, I feel like I've been already in this for 6 years, but it's only been 3 months since we closed the B series, right? So, but yeah, but I actually don't mind. And this is, this is the difference, I think, between us and the big companies. Like, man, we can, we can make some dramatic course corrections really quickly and be absolutely bold and focused. And I think that's what you just, that's the one thing that hasn't changed. Just because we're now scaling doesn't mean we have to behave like a large corporate. We just have to be relentless as as CEOs of startups, right? So that doesn't change really because I felt like, oh no, and I just gotta be more like I used to be at, you know, at J&J. But no, actually we just, you just need to carry on with that rigor and discipline and remind yourself what made you successful.

Yeah.

So that's, yeah, but Great Plastic, but thanks, appreciate it. So that was, we put a lot of effort in that. We've learned, you guys may have heard of Lappiplast, Yeah, so that was kind of the— that was kind of the— I'm like, okay, if lapiplasty can do that in the foot, we, we call it gripplasty and sort of try to replicate what they did in the, uh, in the foot we can do in the hand. That was the inspiration. So I, I give, uh, all credit to Trace and, uh, but they also, you know, they made along, along the way some— they're going also, also through some challenges right now, so trying to figure out, you know, where the, where the errors were along the way, you know, 4 or 5 years into it.

So yeah, yep, yeah, just be careful. Hand surgeons and podiatrists are very different customers.

Yeah, yeah, no, great, I agree. So yeah, we just launched— if you look, we, we just launched our direct-to-patient website only like a week ago, mythumbpain.com. So it's the first one of its kind for CMC arthritis. So yeah, so we're, we're just super being super conservative. I think we're spending about $2,000 on, on, on ads at the moment, so per month. So we're being, you know, just going very, very slow.

My Thumb Pain is what it is.

Yeah, I think so. I think that's what the team told me, My Thumb Pain.

It's not up yet.

It's up.

How common How common is CMC arthritis?

Gigantic.

Number one.

Gigantic.

Number one arthritis in the world.

Really? So Bob, the most common thing to fix it though is they simply remove one of your bones. It's, we're not talking 1932, we're talking 2026, and the most common procedure is to pull one of your bones out.

My thumb pain, my thumb pain, .us.

It's there.

I'm looking at it. Us.

Sorry. I mean, one of the things that separates us from the animals is our opposable thumb. I mean, come on. Yep, yep. Good point.

Well, yeah, Patrick, Patrick, I know I'm not the only one that would reflect this. Uh, phone chat is built this way. We're rooting for you. If there's something that you think anybody can help with as far as pointing you in directions of people to talk to or whatnot, don't be shy.

No, absolutely. I, yeah, definitely, definitely. I can, I can, I can, you know, use any word, any help or guidance on this because it's— I think we have a real opportunity and we got to, we got to beat those, those, those. Nobody should be putting a hip replacement into a thumb, period.

So. Hey, Eric, I've got to sign off here in a minute. But have you ever, do you know Dr. Sadiq Diwan out of Manhattan? I don't know him. He's an interventionalist and he is semi-retired from his practice or maybe fully retired. He is actually a shareholder in my company, but he's huge, huge in interventional pain. He's like the godfather of interventional pain. And he, but he has spent his last 5 or 6 years building programs down in South America. And I, I texted him when we were first talking and asked him if he knew spine surgeons down there. And he says he knows very many, many spine surgeons down there. So if you'd like an introduction to him, be glad to introduce you to Dr. DeWand. He, that's mostly what he does now is goes down there and teaches on interventional, procedures and whatnot. And he networks with a lot of spine surgeons and regenerative medicine. He's big in that as well.

So yeah, that, that, that would help. Um, we're definitely, um, growing down there. So we, we, we found some good places. Um, but have a lot of runway yet, so that would be great.

Cool. Excellent.

I love it.

So I sent, I sent you a connection on LinkedIn if you wanna just connect and I'll, I'll hook you up with Dr. DeWan.

Perfect. Great.

Thanks.

I love bone chat. This is what happens every week. Yeah. All right. Well, I don't, I'll be, I wanna be protective of everybody's time. That's a full hour. This has been really interesting. You never know. I love open discussion days. See you next week. Thanks guys.

Hey Tiger, are you available? See you Tiger. Can I call you for 2 minutes quickly?

Yeah, absolutely, Patrick. Yeah. Thanks. Yeah, I think they're on.

And Tiger, you said the right thing though. This should be discussion day. The hour is always way too fast. Maybe once a year we do like a, like a real big thing.

We could do that. That's a great idea. I'll, I'll broach that with the members. All right, thanks.

Thank you, everybody. Bye.