BoneChat #148 - Open Discussion: Ortho Startup Challenges, Industry Updates & Founder Realities

Yeah, Kyle, I'm happy you're here. Do you still— is that project you're working with that doctor, he's still trying to raise some money? You're on mute.

Which project? You gotta be more specific.

I don't know. There was one you were talking about that we're trying to figure out how to call someone's baby ugly without offending them.

I remember that discussion.

Yeah, I was gonna send something to you.

Yes. So that was a doc that was in a— it was the first MPJ of the foot device.

Yeah.

And he sunk a bunch of money into it, filed some patents. He just has an idea that is fine but not extraordinary, and it's in a space that is just not the type of thing to get anybody excited about buying it until you've put it in 500 times and shown that if you, if you offer it, you can scale it. So, uh, but I have— I haven't talked to him in what— this is the middle of October. It's probably been 6 weeks since I talked to him. So I'm considering that probably Yeah, probably, uh, probably dead for the moment.

I just sent you a list that might be helpful, uh, 60, 70-ish Southern California orthopedic physician investors. So

70 Southern California orthopedic investors?

Sure. Yeah.

So these are surgeons that want to invest money in, in a company that is in orthopedics?

They're either a VC, an investor, founder, Something of that capacity. The breadcrumbs lead them to believe they'll be investors. And yep.

And the— yeah, what Stephen does, Kyle, is very— it's very valuable because it's real time. He doesn't— it took me a while to understand this. Stephen doesn't do— it's not a database of things that happened 18 months ago. It's, it's based on internet behavior right today.

Yeah.

And it's, it's fascinating.

So here's their investor signals, their tiers, their headlines, you know, in their headline, angel investor. So it's about finding the breadcrumbs and then presenting them to you. So

that's amazing. That's amazing.

It's, it's challenging, but yeah. So hopefully that helps. And then there's even some resident fellow, resident investors, founder, entrepreneur. surgery resident, things of that nature.

So, wow.

I will take a deep dive into that. That's amazing.

Yeah, it is amazing. It's— yeah, yeah, Stephen's tools are amazing. They're— because they're real time. It's based on real-time behavior. Yeah, on LinkedIn and lots of other places, you know, today.

Yeah.

And every time, every time he pulls it, it's fresh today. It's not like So that's what makes it, I think, so valuable.

Yeah, we're getting ready, Tiger. We've talked to you about this one, those, those bots, you know, in the world of Grok Bots and Muse, where all our competitors are launching AI chatbots. Our whole thought is, can I have something, can I build something that, that runs the, the monotonous task of your research throughout the day? And then eventually can execute on the emails after they're approved and get smarter. So those are, those are in the works, Tiger. I gotta reach out to Anne. That's gonna be like a November type thing, I think.

You're gonna reach. Oh, and okay, got it.

Yeah,

yeah, November's fine. November's fine. Did I only ask Kyle? You did you? We completely scrubbed all the bone chat notifications and started all over this week. Did it work better?

Oh, I just I didn't even pay super close attention.

That's actually.

I just I opened the email that I usually wait for that comes at one o'clock when it's. 2 o'clock call, my time. Let's see. Yeah, so it looks like I've only got one invite. And let's see. Yeah, I think we got cleaned up. Yep.

All right. Yeah, that was really good advice. I talked to Anne, the Bone Shed admin, and she just erased everything and started all over. And so everybody should get one clean invite. I think it's 24 hours in advance and like 1 hour in advance, something like that. Nice. It'll be light today. NASA's going on. There's, you know, OTA just finished, I guess.

Yeah.

MMVC. Are you guys going to MMVC in Memphis?

I will be. Yep.

Cool. Are you presenting or are you just—

Nope, nope. We're just going to attend. It looks like a good presenter list. And then SmartTrack is holding a data conference in August. day before AUKUS the following week. So it's gonna be very interesting. I'll be there as well the following week. Hmm. So I, I have, um, something I'd love to get both your brains on, uh, and it's a future look of what we're trying to accomplish here. Uh, okay. And we just— this is very ugly in its current state, but I'm about to show you. But we have done very well recently With smaller to mid-sized companies feeling as if there has been a physician claims data bubble for the reps. For the executive teams, it was great. It was directionally— it was somewhat close. But the second they brought it down to the reps, there became this contention here. So you're seeing this specifically in orthopedics, this exodus, if you will, of the Acuties of the world not really being able to retain a lot of their business. Which leaves us to kind of figure out what is the opportunity here for, for us to say, how can we capture the enterprise level and try to accomplish something that the other companies aren't looking at by using the datasets that we kind of talked about, Tiger, the live data? And what we've really come up with is a focus on training programs and facilities being able to properly identify— this is very crazy, ugly. This is for one program, but we'll be able to do it for everyone. We'll be able to essentially identify where every resident is, where they're going to, where every fellowship is, where they're going to. So Stryker, Jane, every company has a fellowship tracking program. Arthrex does it a step further and does great at the residency level. But something of trying to capture data like this to say, okay, I'll want to know everything about every resident that's gone to HSS. where they've come from, what medical schools, and then the fellowship side of things where every fellow came from to essentially try to help identify where potentially to invest resources into the next area, if you will, you know, of the next facility. So this is again a very ugly way of looking at where since 2010 to current day, where all of the residents and fellows are coming from. where they're at now, years that have started, you know, kind of the trend over time, the programs that feed HS for the residency schools, clinical fellows by prior residency. I mean, there's a ton of data here. It's like a talent pool.

I'm surprised there's not a lot of international fellows.

Not as much. Not as much. There are some. We have some international flow. Maybe it's in a different data. platform that we had. We had some that showed how many people were going overseas, but we got rid of that on, on this one. So the kind of concept is this is super powerful data, but what to do with the data, you know?

Yeah, I can't think of a— I can't think of who would want to know where residents have been and where they've gone.

Yeah. Like,

I just don't know. I mean, back in the old days, Zimmer was the first one to— you guys are too young, probably. Maybe Kyle, I don't know. But Zimmer started a fellowship training program for knees and hips back in the '80s. They were— they had these giant 18-wheeler trucks that they would go park and train. Yeah. And of course, when you get out of residency and, you know, And the only thing you knew, only knee you knew how to use was Miller-Galante. And then that's, you were gonna go to some hospital and say, call, call me the Zimmer rep. I need to use Miller-Galante.

Yeah. Yeah.

That was, that had more, more value back then, but that was a, that was a very expensive way to pre-sell.

Yeah. This can automate that whole process because Stryker has, I was part of the fellowship program there. It was a very manual task. Um, we have first version of this in our platform now to track all the fellows. Where are they? If you've done well at a— well, done well at a program, you would track that. And when they leave and change their jobs, there's an update as well. So whoever that rep would be in that area could get a notification. But the kind of the concept I'm trying to think of is, how do we go deeper into the level of the hospital? Who are the key consultants there? What— You know, if I'm Stryker, all of a sudden I see there's 16 Smith& Nephew consultants and what they're paying there, is that, you know, do I not invest money in there or not? But yeah, this is pretty robust list of everybody currently, and, and up back to 2012, 2010, you know.

Can you, can you combine that with, um, first publications? Like, you know,

Yep,

because that's— I think there's a gold mine in finding early fellows that were trained, and now they're in practice and they're public. They've done their first publication.

So the goal would be, once they're in here, you know, I'll go to our version of it right here, Signals Fellowship. Let's go to, you know, Vail or HSS. The goal would be when I click on someone, It would go down this path to see if they've done anything. Um, they may have, or it may have not. They didn't here.

Not registered. Okay.

Yeah. So like, if I go to see chief nursing, chief executive trauma, this doctor right here, it'll bring them to a profile like this, essentially pull up everything live that they've done, their clinical trials, their patents, their YouTubes, their— all that fun stuff. But to make, you know, what you just saw in a better format that is more like this level. This takes about 30 to 60 seconds sometimes, how much information we could pull. But it's all— yeah, it's about 150 live calls that are happening.

Wow.

So, um, and kind of going through and parsing all this stuff. But yeah, I don't know, the data is, is very interesting, it's powerful, but how— what to do with it at what point, you know?

Yeah.

So,

yeah, so I think you're— I think you are— you You're doing this the hard way, which is you're kind of doing it backwards. You're kind of saying, here's a really cool tool, I'm not sure who needs it. I mean, I— you can do almost anything with real-time data now, Stephen. That's not a problem. I would probably go back to fundamentals and say, what information do people need that is not available yet?

Yeah.

You know, I mean, and you just— and you have each— you have medical device companies Physician practices, distributorships, you know, just take one at a time and figure out what, you know, what do they need to know that they don't know in real time?

Yeah. Yeah, our thoughts are there's this enterprise miss from us right now. We're doing great in small companies, middle companies that are looking for distributors, looking for data that's elsewhere. What can we do with this training data to essentially say, hey, the fellowship, the residency programs, Like, I don't know. I hear what you're saying. I

hear. Yeah. So who's the guy? Who's that guy that looks like Santa Claus? He's got the great beard and he's— he helps physicians with their physician practices with their social media.

Matthew Ray Scott.

Yeah. Matthew Ray Scott.

Yeah. That's funny. What a way to describe him.

I knew it. I knew you guys would know who it is.

He came in my mind. I saw him, but I couldn't think of the name. I know.

I couldn't think of his name either. I would, I would have— he's plugged into physician practices pretty well. I would talk to him, Stephen, and give him a tour of what you can do and just say, where, where's the biggest need? You know, he may partner with you or he may, he may, you know, give you some ideas on your own.

Yeah. Yeah. I've got, I mean, a couple, and this is mainly trying to say like the Strykers, the Smith nephews, the Zimmers of the world, what can be, what would, what more would you want out of this data now you identified all of your leads for the next 10 years as they get in. You know, it's like lead generation internally. But yeah, yeah, Matthew, I've got to reach out to on, on the—

Matthew's— yeah,

yeah,

I think he, he's— yeah, he's plugged into what physician practices need better than anybody.

Yeah, yeah, I think he'll like this one. You know, this website builder one that we did, this is the one that I sent you. Just took 4 minutes and not a word was typed in.

That's incredible, man.

Pretty crazy.

It's amazing how you can spin up, yeah, a website. You can attach a chatbot to it, you know. It's just crazy.

Just like this. We can do one live if you want to for someone, and you send it to someone. Takes 4 minutes.

Crazy. Yeah, it's— yeah. Wow.

Yeah, I mean, you could change a picture right here. Sorry to take over the screen, y'all, but this is cool.

The tools are amazing. You just got to find the need. Yeah, it's exactly like starting a medical device company. You've gotta, you know, everybody's going, hey, I got a better idea for a total shoulder or total ankle. But, and it may be really cool tech, but are people gonna pay for that? You know,

so

here comes baloney. Yeah.

Stop sharing there. Yeah. The, the website one's crazy because it, it'll cost someone $25,000 to do the same thing.

Yeah, I know.

Yeah, it's crazy. Mark, how's it

going? Hey, Kyle. Hey, Stephen. Long time no see.

I know. Oh, it's good to see everyone.

I just had Stephen on another call an hour ago.

That's what he said. Yeah.

Oh, did he tell you a little bit about it?

He didn't. He just said he's working with you, but that's all he said.

There's a— I was telling him a little bit about MD Launch and just kind of that thing. He's like, Mark, Mark would be helpful on this one.

We, um, I, um, I'm spending a lot of time and money, uh, building an indie community for independent medical practices. And there's a gentleman in California who's a practice manager that owns a Facebook page with 3,100 practice managers. And, uh, we're just in discussions about merging. And I invited Stephen on today to show a couple of his whizbangers. And it's you know that was it was an interesting call, wasn't it, Stephen? I mean,

yeah. I mean,

he was very practice manager-y.

Yeah, yeah.

Which is good. I have to learn how to speak that language better.

Yeah, yeah. He's a nice guy. What he's trying to accomplish by before I mean investing the money into that platform is just hard. I mean, a community tiger of like. 3,000 independent practice managers and they're very engaged on Facebook, but he's talking about investing a significant amount of money into their own community portal and app. And you're asking just for a very frictionable moment to move somebody over where they're engaging right now. Scary.

Very scary. I could feel— I could literally feel your head exploding.

I think, and Tiger probably better than anyone, getting an engaged community to consistently connect on what platform you want to is so much harder than most would think.

The problem is, we just talked about this before you got on, Mark. The challenge is finding the problem to solve. It's now the tools now are unbelievable, and Stephen's got his finger on the pulse of all these great tools. And what I didn't understand immediately on the front end is he doesn't do databases. Databases are stale. He does real-time behavior on the internet. He can find people that want to invest, people that want to do anything based on today's data. It's incredible.

Yeah.

But you gotta find that what— so the question I asked Mark is if you go to each potential customer, if you go to physician practices, medical device distributors, OEMs and so on. What, what's their biggest need? And I bet you anything Stephen could spin up a tool for them for with that need. But what's, what, what is their biggest need? It's, it's usually getting more patients in the door for pay, for physician practices, right? Yeah. Yep. So, so, so patient leads is everything.

So there's a, a guy I know in Pittsburgh who runs a company called PracticeBeat, and they, um, they basically, they promise you new patients in the first 30 days.

Wow.

Yeah.

And they're using traditional social media, probably?

They're using— the guy basically speaks Google, all the different dialects of Google, and, uh, makes your independent practice typically Visible or more visible than the hospital corporate practice.

Got it.

And that's how they, that's how they guarantee you new patients or your money or, you know, or it's free.

Yeah.

So it's kind of the new SEO kind of thing.

It's kind of an SEO on steroids. Yeah. It's a very extremely effective SEO. And I think, I think what Stephen's doing is even better than that.

Yeah, SEO takes a lot of work. GEO, if you can direct— I mean, then you have to continuously be updating all of your stuff. The second it's stale, you're here, update, you know, it's wrong. But if you can use AI to essentially say, hey, ChatGPT, I'm, I'm well qualified, especially with majority patients searching there now, I think that's awesome because you don't have to run, you know, LinkedIn ads or Google ads or anything like that anymore. Now you're, you're directly writing.

Right.

Where the patients are searching.

So basically by making yourself visible to the AI chatbots.

Yeah.

Or Claude or whatever, you're, you're, you're, you're leapfrogging over Google.

Yeah.

And you're leapfrogging over SEO. You're making SEO obsolete.

Yeah.

Because when's the last time you Googled anything? I don't Google anything. I go to Claude or, or ChatGPT. And I asked them.

Yeah. And, and so here's a scary, here's a really scary fact. It's about 3 weeks ago, the age, the bot agent traffic on the internet passed human traffic. So, so now it's 51% of all, of all traffic on the internet is, is bots. And it'll, and in a, in a couple years, it'd be 100 to 1. I mean, it's not even— I mean, that's so you— what your new customer is, is bots and agents. You've gotta figure out how to train the bots and agents out there that you can, you know, who you are. It's the— it's crazy.

It's— we've had to implement different rate limits for bots coming on, but people putting bots onto different platforms of ours where you can see it just continuously searching Every 36 seconds, pretty much like then they were smart. Okay, I'm gonna go to sleep, but I want you, Claude, to sit here and research and scrape things. And we'd find so many problems. But the bots, the bot side of things is very challenging now. You have to optimize your websites for bot activity, which is crazy.

Wow.

Yes, I heard a very smart person say it's like employees. So if you have 2 employees, that's manageable. But if you have 100 employees, You know, if you have 100 bots and they're not talking to each other or making decisions correctly, it's organizational complexity of managing agents is, is gonna be the challenge, I think. Wow.

Yeah, you need a chief of staff orchestrator to talk to the rest of them.

Yeah. Yeah, I've got, I've got my Grok bot going, man, that thing is unbelievable. It blows me away every day, you know.

It's crazy how much more you can do with less now.

Yeah, I've got my, I've got, I can, I just talk to it on the phone, just say, you know, move this meeting, go find a better price for this, you know, get, you know, I've got my annual physical coming up. I, you know, ask, remind me to ask the The physician these questions. It's just amazing.

Yeah.

Who are you talking to and which, which bot are you using?

I use, I use GrokBot because I'm a big X user.

Oh, you use Grok? Okay.

Yeah. GrokBot is— Grok Muse Insight is probably the best one, but it's harder to get in. You need a referral.

Yeah. GrokBot's pretty good. Muse, they just said that they're, I mean, they're capability or their logic on there is like right up there with Opus 5.5 now.

Yeah, Jim, Google just leapfrogged their model. So here's the thing that Google— here's the thing Google has that people don't realize. Or no, I'm sorry, Facebook. We're going back to Facebook. Yeah. So Facebook's got 3.6 billion users. I mean,

20% of them actual humans.

Yeah. But they're in every country. If you buy a phone in Malaysia, it's— they— it comes with Facebook automatically. You get a Facebook account when you buy a phone. They have these deals in other countries where they, they just— they got the tent, the camel's under the— get his nose in the tent, and then somebody in Malaysia is using Facebook for the rest of their life. Wow. Yeah, the rate, the breadth of Facebook's unbelievable and Google too. So they're gonna find a way to win.

Those 2 have the most data on you and they're just gonna be able to optimize everything you're doing eventually.

You know, Facebook has done to phones what Synthys did to residency programs. They're in every one of them.

Yeah, that's true. AO Foundation.

That's what we talked about, that.

Yeah, yeah. So we get— these tools are unbelievable, and, you know, only less than 1% of people know how to use these things like Stephen. So we've got to find where, where the need is. And, you know, I think you could— any business where you're, where you are providing a A paying customer lead is, it will, is always has a value. It could be a patient, it could be potential, you know, hospital to buy your products. Anything with a warm lead, people would pay for that.

Yeah.

Tiger, you're using still a personal assistant, correct?

Yeah, I've used Anne. Anne's a real person in the UAE. She's, she's very, very organized.

So what do you think is happening to her specialty in reference to AI? Is she now using AI to make her job faster, easier, better? Or are people skipping over the personal assistants and going right to Grokbot?

Yeah, I think personal assistants are going to go by the wayside. She's using, she's a low bandwidth user. She uses Claude. No. Yeah, I think she uses Claude, but just to help her write and things like that or rearrange a spreadsheet. But she's not using agents herself. Yeah, you're right. They're gonna be replaced. I mean, you're, you're, you're these, these new bots, GrokBot, Muse, Insight. What are the other ones? They're really limited by your imagination.

Yep.

I mean, you, you have to, every time you do something, you should say, can I, can the bot do that?

Yeah.

And the answer is usually yes. The, the, the, the sandbox that these things play in is anything you can do on your computer. They can do for you. They can, they can, they can research, they can buy things, they can sell things, but they can't, you know, deliver DoorDash to you. Well, they could order DoorDash, but they can't physically go do something. So, but they could, you know, think about what you can do on your computer screen. You can make calls, you can do voice calls. Grokbot just added a, you can add, you can give it a phone number. Now, this just happened a few days ago and it'll go out and make calls for you. It'll research, you want a lawn service, it'll interview 10 lawn services and rank them and tell you who to use.

Crazy. I

mean, it's just—

But it can't cut your grass. It can't cook your food.

Right. They can't cook your food, but they can, you know, if you need an expert to help you, they can, they can help you find that.

Oh, I saw a pretty cool AI grass-cutting robot the other day that maps out your whole yard and it'll go and cut it and edge it and everything.

I've got, I've got a, I have a robot lawnmower. It's awesome.

Oh yeah, that looks so, it looks so cool.

It's, I've got the Eufy one. Eufy, you know, they're known for their vacuum cleaners, but they have a robot that lawn, and it's, it's just vision-based. And it only goes where the grass is. And then once, once it learns where the grass is, it, it goes out and cuts it and then goes, parks itself in the little garage. It's—

I've got a meeting tomorrow with the University of Miami Biomechanics Lab to pay for a study. I mean, to organize a study, really a test. We're going to take 4 specimens, 4 matched sets. That's basically, you know, 8 legs. Okay?

Okay.

And we're going to do a new kind of an ACL fixation system on one, like the left leg. And we're gonna use the Arthrex system with the endobutton on the right leg. So then I'm gonna ship them all down to Miami. And I need them to be stressed tested and all that. What do you think it's going to cost? That's the reason I tell you this.

Oh, I'm going to go

back

up.

You're, you're, you're providing the specimen, you're doing the install, you're just sending them to them so that they do the mechanical load of it.

Yes, yes, yes.

You're asking the University of Miami service fee to do the test, right? Well, are you talking about the whole thing?

No, I'm gonna find out tomorrow. No, no, no, I'm just— they're doing— they're just gonna do the testing. We're doing the, uh, here in Atlanta, we will deflesh the specimens, uh, perform the ACL, and then I will freezer pack them and ship them to Miami overnight, and they will then test them the next day.

And they're gonna do some sort of range of motion or You know, distraction testing, rotational stability. What—

I guess that's what we're going to discuss tomorrow. It's going to be, you know, it's going to— we're trying to make it as valuable as possible. But probably the most important thing will be, you know, whatever, whatever constitutes to loosening or pullout, you know.

And what will the data be used for? Is it just new product development data, or is this for regulatory purposes?

Not for regulatory purposes. Well, it could be for regulatory, uh, mostly sales and marketing.

Okay.

Yeah,

interesting. I'm gonna say $200,000 to do that.

$200,000?

That's fair.

No, I was gonna guess $10,000.

Yep. I was gonna say $15,000.

Maybe, yeah.

I was going out more north of 50.

North of 50. Yeah.

I mean, it just depends. So it doesn't look to me like there's a— is there a specific ASTM for ACL reconstruction that you're aware of? Or is it more related to just standard pullout of fixation devices?

Wait a minute, what's an ASTM?

American Standard Test Methodology. It's typically what you test to.

They typically use the Instron.

Okay.

That's the equipment. But that, that—

And you specifically said this is for ACL reconstruction?

Yeah. So typically they, they load, typically they will load it and I guess they just simply do this till it

fails.

Yeah.

Yeah.

Oh,

so like a, a dynamic stability test, a dynamic. Yeah. I mean, so you should spend, if it's one machine, 6 samples, 100,000 cycles. Yeah, you shouldn't spend more than 10 or 15 grand for that maximum. Yeah. And that's probably being generous. It depends though if there's extra configuration for fixtures they have to make or special clamps and equipment. There's, there's other factors, but, um, I would— Canyon Labs, Nelson Labs, Knight Mechanical Testing, which is now ATI. There's a lot of places that do mechanical testing and stuff like this at a very, very reasonable rate. So if, if they come at you with a price tag, you know, in the $50,000 range, it's probably worth thinking about.

I'm gonna call you.

Okay.

Okay.

So I used to work with, a million years ago, Lauren Lotta at Miami. Is he still there?

He is on the email chain for tomorrow.

Okay. He's been— he's been around a long time.

I don't think he's going to be on the call, but he's— he was on the email chain.

Yeah, he's a good guy. I did— I paid for some testing at the University of Miami 30 years ago. I've forgotten now.

Uh, and the guy I'm talking to is, uh, he's the PhD guy. You know, all these, these, or these red, these orthopedic departments, they've all got like a, they've all got a PhD guy.

Well, they gotta have projects to work on. And so they're at a university hospital. They, they, they, they're looking for projects to feed the PhDs.

Well, I mean, well, Kyle's comments were gratifying because I just gave, I threw out a very round number to the sponsoring orthopedic company in France. Of $25,000 was my— was my kind of ballpark estimate, including the specimen cost.

Wow. Specimen. I was throwing the specimens. If you're buying the specimens, it usually— the price goes way up, um, rather than borrowing the specimens at like a Mary Lab in Memphis

and then returning them.

Yeah. Or you—

yeah. Or somebody does a total hip on a leg and then you use the knee after that.

Yeah.

Sort of thing is what you mean. Yeah.

Yeah.

It's tough, it's tough to do that. It's tough to do that for test, for testing because usually you're more isolating.

Yeah.

A specific bone.

I had a lab and I mean a processing, whatever you call those things in Knoxville that I used to buy specimens from. And I still have probably half a dozen feet in my freezer at the office.

Yeah.

And they, you know, they didn't ask for them back. They, uh, the guy that I knew would drive them down, uh, or I'd meet him halfway. It was so old school. It was like the first time I ordered specimens, uh, a long time ago from a place in Utah. They didn't ask who I was. They just wanted to know, you know, where's the shipping?

Body snatchers. That reminds me of an old story when I— and I may have told you guys this once— when I first started at Smith& Nephew in the '80s, we would buy full bodies and have them shipped in, put them in the freezer in the biomechanics lab. And somebody said, hey, they just got— Pakistan is selling A whole body for like 1/10 the price. And so we started buying them from Pakistan, and then one of the engineers noticed they all had a stab wound in the back in the same place.

Kidney harvesting.

Yes, like, oh no. So we immediately stopped buying from Pakistan.

Oh man.

So one of the things that, you know, when you join a startup, there's a lot of shock to the system if you've been in bigger companies, right? And it's also what makes working for a startup very valuable is it has a way of resetting your system and thinking differently than if you're at a gigantic company.

Yeah.

And where that just smacked me right in the face, and this is 13 years ago at this point. Is when I went to Sonoma and our CEO said, because I was working on cadaver lab plans and we were going to go to the OLC and maybe we're going to use the Mary, and you know, we're looking at and we're getting these $25,000 quotes for lab fees. And our CEO goes, CEO says to me, well, why don't you just make a lab in our warehouse? And this was an office building in the middle of Buffalo Grove, Illinois, and we had an empty warehouse in the back with like a loading dock and nothing. It was just cement. And I thought, What are you talking about? Like, I can't possibly have a cadaver lab here. And yes, you can. And so within a month, I had put together shit from Home Depot and registered and done all the things, which really wasn't very much. And I had body parts and torsos and pieces of human flesh on a table, uh, with, you know, drapes and an autoclave and everything. And it was— it wasn't too difficult. And it was one of those items where you just— you get shocked. Like, it should be more difficult than this to harvest body parts. But nope, people are selling them. And as long as you're paying the bill, you can do it. And that's, that's stuck with me for a long time.

Wow.

We, we, we still do labs at the Ramada Inn or the Holiday Inn. We just rent, rent a big room, put down plastic.

Put down plastic. And then there's a wedding reception 6 hours later. Put a,

put a sign out, enter at your own risk.

Yeah. Oh man. We did it way back at Smith and Nephew. We, we were working on a new, uh, polycellulose porous coating for hips. It was supposed to be a low modulus coating for bone to grow into. And we were making little canine hips. And we had this stray dog walking around, and somebody grabbed the dog one day, and we implanted— anesthetized him and implanted the hip in the dog. And we kept feeding him and he would come back. And then one day he disappeared. We figured he got hit by a car or something, but he disappeared before we could, you know, sacrifice him. I mean, geez, there's— you could— it's amazing, the stuff.

That's wild. I

mean, you know, I remember the good old days where you could take prototype instruments into the operating room with no paperwork. You could. Yeah, you

still can. You still can, Tiger.

Really?

Not if you work for Zimmer.

Got it. Now I understand. Quality. Yeah, the quality people go bonkers if you try to pull that off in a big company.

Yeah, it's perfect. If you have a company that doesn't have anybody on the quality team, then no problem.

You— yeah, you are. You're head of R&D and quality. Yeah. And marketing.

Dangerous.

Let me tell you guys what we're doing at Indie Community, and you can give me your opinion. So obviously Indie Community's purpose is to help independent medical practices and surgery centers. That's our, that's our goal. And, uh, the main reason is because, uh, I think it's, I think I like, I just, I have a great admiration for them. Uh, and a lot of them are orthopedics. So we're going to form, uh, 2 advisory councils. One will be on the professional side, that is administrators and physicians, owners. And the other will be the industry side. And so what value do you think we could best bring the independent medical practices, and how do we serve that value to them Knowing we talked earlier about engagement, knowing that it's hard to stop for a webinar, um, how do you get that information to them on, say, a rotating monthly basis? Like, you know, this month we were going to talk about YON, revenue cycle management. Next month we're going to talk about, uh, you know, MD launch, website building, and so forth and so on. I mean,

are

you charging for this? I don't want to reinvent the wheel. We all know this is hard to do.

Are you charging for this, or is it free, or it's

a— the, um, it is free to the members.

Okay.

The professional, the, the medical practices.

I'm a big fan of newsletters because you can read a newsletter on your free time. It's asynchronous. And you can put links into newsletters and, hey, you know, here's, you know, you can put, here's our topic today, something helpful for physician practice. But here's, you know, if you want to learn, if you need, here's a whole toolset. You can just click on any link. I'm a big fan of newsletters. And the other thing I like about newsletters is you have a direct You have a direct relationship with the person reading it, which is different than go— if you go through Facebook or Google or websites, you know, it's, you're, it's indirect, but websites are direct. I mean, I'm sorry, newsletters are direct. So I would, I would create a monthly or weekly email newsletter. And have— you could have, um, you have surveys, polls, you could have— you can even have discussion, community discussion groups and, you know, stuff like that.

So I think the, uh, the newsletters— first of all, I think you're showing your age. And I— because I agree with you too, by the way, because it's much— to me, it's much faster to read. And more efficient. Uh, and having said that, then why is video so incredibly popular?

Video is popular because you can do it while you're on a treadmill or walking. Um, the problem with video is usually one person talking to, you know, 1,000 people at the same time. I don't know. You're totally right. Young people, anybody below 40 is gonna, or below 50 is gonna be consuming almost all their content in video. You're, you're totally right.

What about audio without video?

Then you're, that you're into old-fashioned podcasts there. Okay.

Long-form podcasts do great. Short-form are rough. What I just sent you, Beehive, this is very interesting. If you just kind of find some YouTubes and podcasts actually from the founders of this one, they'll talk about the resurgence of newsletters have just blown up and so many courses and everyone, people are using, and this brand makes it very easy to distribute and track and the analytics and build them and, and all that. They've said that is just an amazing, one of the best forms of content and Growth, user growth as well.

His newsletter.

Yeah. Yeah.

So what turned me on, Mark, is there's, so newspapers are dead, all newspapers lose money, but there's these new entrepreneurs like Morning Brew. Have you guys ever heard of Morning Brew? Yeah. So they, Morning Brew has started off, they've sold their newsletter for $200 million.

Yeah,

I mean, it's insane. It's free and it's just, it's an ad-based thing. But it, if you read it, it's, I mean, it's really good stuff. It's just what's going on in the world this morning and it's, and it's, and it's just very well written. Um, and it, the, the, the other thing about newsletters, the more narrow the niche is, the More the better it is.

Yeah. So content is king on it. It has to be extremely well-written and useful content.

Yeah. I mean, you've got, if you go super narrow like midget wrestling, you know, you, you're, you're gonna have 1,000 people that just, just can't wait to get the next newsletter because they're in that space. Physician practices is huge. It's just, it's almost too big. For newsletters, you may have to, like Morning Brew, they branched out into subspecialties. Yeah. You may, you may have to, I don't know what topics for physician practices, finance, P&L stuff would be really important. Patient recruitment would be important.

I mean, I mean, there's a lot of, lot of possibilities there. It could be, you know, technology.

Oh, technology.

Yeah. You know, I always think of technology, how to make more money, um, personnel staffing. That's, you know, your number one cost is always people, right?

Yeah.

Um, anyway, I just, I just thought I'd throw it out there and I like the newsletter idea.

Yeah, I kind of like it. The hard part about the newsletter is 2, there's 2 things you gotta collect emails from people that are really interested in that. You're always harvesting emails. It's hard to do. It takes a long time to go from—

It's easy though.

I know a guy. I know. All right. And then the second thing is like, like Stephen said, creating, you have to create really compelling, useful content.

So, Stephen, that, that's one, the one thing that surprised me on the call with Eric is when I was sort of suggesting bridging his practice. He has 3,100 medical practices.

Wow.

Yeah.

Uh, that are part of his Facebook group. And I said, wouldn't you like to have all the, you know, the contact information of who, who works there? Yeah, all this. And his response was, I would rather they give it to me themselves.

Yeah.

So he must have thought about that ahead of time, or is that a knee-jerk reaction to a non-techie guy? I don't know. What do you think?

I don't think he's very technical because he's willing to pay someone $16,000 that he can spin up himself, you know. So he's not willing to do that. Or like—

It was crazy, wasn't it? Yeah. I didn't— I wasn't saying anything either.

Yeah, um, the $16,000 versus going and doing something like Circle, and there you go, you're done for $120.

I mean, I was waiting— I was waiting for you to say, I'll do it for $5.

Yeah, I thought about it. I've got to get to sleep at some point. But, um, I—

It surprised me though.

Yeah, it surprised me. I think it's so, you know, like, I look at what he's doing, you're like, okay, well, it is reproducible if you trade a 5 out where people are complaining about these things? Can you find these people at the point of intent? Or can you find them when they're talking about LinkedIn, on LinkedIn or Twitter? Like, you can reverse engineer his list almost. But, um, I don't know. It was a very interesting conversation.

Interesting. What another thing I like about, uh, Eric, he's in a really interesting kind of rural area. Yeah. The Fresno Valley there.

Yeah.

And it's a family medical practice. Yeah. You know, that's not our language.

So I wanna show you something. It's something both of you guys have been talking about real quick. Product called, and these are out there, this is not the only one. It's a product called LeadPipe. LeadPipe allows you to do is pixels on websites, track your website traffic coming in to know who essentially is, but you can also build an audience to see who's searching For what you're looking for, and so I've been playing around with this all day so I can actually try to find and narrow it down like doctors that are searching for website builders. When it gets into healthcare, there's not a lot of information out there on on kind of who's searching for what is very challenging to do. So when then you put a private practice, private tutoring, there's not much private private. Medical, nothing found, no topics found. So it's just, it's like such a niche we think is huge, but when you're going through, this is such a niche group. I mean, it's hard. I did it. I actually took Matthew Ray Scott's kind of thing earlier, actually, the feed, the agency, and essentially tried to reverse everything that people would be searching for, and it just went all over. It couldn't figure out what it was from like the orbit, if you will, people searching for those concepts. It's hard to find when, like, Google Ads and things like that to really go after people for indie practice. So, um, trying, trying right now really hard, but it's—

Yeah.

These things are interesting though, because this one's free for your first 500 users. Um, but anyone that goes to your website and spends any time on there, you actually can track their IP address. You can figure out who it is, who they work for, and get their email address.

That's pretty cool.

Yep.

That, that would work for DevOps.

Yeah. So you talk about kind of, you know, Tiger, all these different bots. I've got one that is going to take this and have a Grok bot that is my outbound research every day. Go check this to see who came and write them an email. Yep.

Yep.

But yeah, yeah, these things are— there's, there's so many companies that are doing it. Once you get into that data side of the world, it's interesting. It's interesting. Stop sharing. I almost, almost left the call by accident rather than stop sharing.

That's what I did

earlier.

Yeah, it's hard.

So, Mark, your FinOps is doing well, right? But it's just scale. Are you just finding new customers is the issue

or? You know, FinOps has been a part-time business with a full-time operational staff. Okay. We've never lost a customer. It's super sticky. But building new customers at the individual medical practice level has always been real challenging. You know, it almost costs more to recruit one practice than it does that they pay.

Well, that's what I was thinking. Stephen could really help you there.

No. Well, no, it's, it's why we talk a lot.

Yeah. Yeah.

But at the same, you know, 'cause what he's doing is fascinating. But my whole purpose besides personal admiration for building any practice is to build a community of independent practices that do need compliance, and they need many other services.

Yeah,

but selling compliance is like selling insurance or socks.

I mean, it's

just like

everybody needs it, but it's not your first thing.

Oh boy. Yeah, if it's not Christmas, you don't want to hear— but you don't

want to look at this stuff.

It's just, it's really, it's kind of boring. And, uh, I do get, I get one or two calls a week or inquiries of somebody that wants to acquire VenOps.

Hmm.

And then they find, because they want the compliance space, but once they find out we're less than, say, a million in revenue, they lose interest because they have kind of a model, uh, that they want to build and they don't really understand the independent medical practice market in any way. Um, anyway.

Interesting.

Yeah. Interestingly boring.

Well, you know, the boring stuff is where the money is, you know, picks and shovels, right?

Oh yeah, that's the classic 49er story, right?

Yeah, exactly. That's for people that made the money.

Don't go mine for gold selling picks and shovels.

What about legal services for indie practices? Because they all have malpractice insurances and things like that, right?

That could be, you know, that could be a great monthly focus.

Yeah,

actually.

And maybe I remember when I joined my first startup, we had incredible benefits and I was like, how do you do that, you know, with like 5 employees?

Yeah.

They said, well, you know, we buy, they take 1,000 startups and they basically create a, they, you have economies of scale. So So if one of your employees has a heart attack, everybody's premium doesn't go crazy, you know, because it's shared with 1,000 other companies. So I was thinking you could do that. You could do liability malpractice with— you could probably spread that out, you know, with lots of practices and probably get their rates down. I don't know. I don't know anything about insurance. Insurance is—

Our biggest— VenOps's biggest client is a medical malpractice insurance company,

huh,

that pays us to help to do it, do what we do for their clients, for their customers. And they do it as a value-add, um, and the majority of their practices are big ones. So our cost is like this compared to what they make.

Yeah.

That's a tough market. Oh my God, it's a hard market.

Market. Yeah.

Yeah, it really is. So who knows?

Wow.

Anyway, Kyle, what are you working on these days?

Yeah, what Kyle's doing is stealth startups. He can't talk about

them.

Oh, really?

I am doing 2 and working on number 3. And yes, I can't talk a whole lot about that. But it's all, I mean, I'm just, my world is the R&D space. So designing stuff, working on IP, trying to skin the cat in a different way. And what I have found is that I think my favorite place and maybe the most ripe place to be is after 2 or 3 players have entered the market and, and kind of broken the ground. And then to come in after that, learn lessons from them and just be faster than everybody else. So

I like that.

Fast follower, fast follower works, especially if you come up with a better solution.

Yeah.

Because you got the regulatory path proven, people already buy it. That's proven. The margins are right there. Yeah.

And Zimmer Smith and Nephew and Depew will take 10 years to get there. But if, you know, if let's say I don't know, pick some middle-of-the-road companies, Exactech or Advita, and, you know, Orthofix come up with something and it's gonna maybe blaze some trails. If you can come in on the heels of that, then maybe you, you actually have value that one of the big players can pick up. So I'm trying to play in that arena in a couple different ways.

Nice.

You guys know what gait analysis is, right?

Oh yeah.

Mm-hmm.

Yep.

So, there's an Austrian company that's going to be in my office on Monday called STAPP1, 2 Ps, S-T-A-P-P-1. And what this guy has done is, in addition to measuring the pressure, you know, that your foot puts down, like a gait analysis would do, his sensors measure what they call inertial movement units, which is the torque, The roll, the movement, basically all of that together. And the question is, how useful is that information for a patient who's healing, recovering, rehabilitating? You know, if you tell them 50% weight-bearing and this thing can measure 50% and Make an alarm go off on your phone. Does that help? So this is the— this is a conversation my reps have been having this week about lining up this guy to talk with a couple of doctors. And the doctors that they're talking to are just yawning.

Oh.

They're like saying,

that's PT. Yeah,

I don't— you know, that's more— it's— I don't— I don't need information that I can't fix. But I don't need information about something I can't fix.

Right. It's what do I do with information? It sounds like plenty. You're

very surgeon-oriented. And, uh, so, but however, I was thinking today, okay, so what do you do with this? And I got to my— I got to thinking, I'm going, you know, this is the first of its kind. What if you tied it with remote therapeutic monitoring and all those billing codes? Now the PT can make money.

Anyway, did you watch, uh, Plethy, the Plethy, uh, presentation, Mark?

I don't think so.

Yeah, you should go back and watch that. So

how do you spell it?

Uh, P-L-E-T-H-Y. It's what— it's a super hot startup. They basically use video. They— I mean, they use cameras, your cell phone camera, to to do pre-op and post-op. It's, it's incredibly— and there's a big AI component. But we had, you know, we had Jamal on. He's the CEO. He's, he's a fascinating guy, really smart. Go back and look at Plethy. You'll be— Jamal, huh?

Yeah. Not the Jamal that just went over to MIAC, different Jamal, right?

Uh, oh, I mean, no, not the Jamal Miyock. Here, let me look up Plethi. Stephen, can you look it up faster than me?

Uh, he just

called you out, Stephen.

Yeah,

he's got a little thing in his brain.

There you go. Uh, Rod. Yep.

Yeah, Raja. Raja. That's it.

Yeah.

Yeah. Uh, let's see which one it— anyway, just Google, um, Bone Chat and Plethi and it'll, it'll pop up.

Okay.

But that was fascinating. I love that business because there's no hardware. You know, it's—

What a weird name.

It is a weird name. And he's a little different. He's a little different CEO. He's a little bit like talking to Gandhi. You know, it's like there's a— you know, he's trying to help mankind. And, you know, if he makes a little money along the way, that's fine. But they're— yeah, I think they would— they— Plety may be interested in that. You said it's from Austria or France?

Vienna.

Yeah. Okay. Yeah. Yeah, the Austrians and Germans are good at that stuff, aren't they? Yeah,

they're funny.

Well, you're— so we're at the end of the hour. So you and Dan and Dennis are up next week, right, Mark?

Yeah, that'll be fun.

That'll be fun. And I'm gonna— I'm just gonna sit in the back and let people in the room, and I'll, uh, and I'll try to— we'll try to get 15, 20 people, uh, draw in for that. That'll be fun.

Yeah, yeah.

I talked to Dennis earlier. I reminded him, I said, don't you— don't you ghost me, because he is on an airplane every other day. That boy, golly.

All right, guys. All right, good hour. Thanks, guys.