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IC308-2021: Orthopaedic Innovation: From Inspirati ...
Questions and Answers: Orthopaedic Innovation: Fr ...
Questions and Answers: Orthopaedic Innovation: From Inspiration to the OR
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So if I can have the faculty come up real quickly. And while you're coming up, I'll start with the first question that I have. Obviously, Nat, you came in and started some companies and exited more quickly. Steve has hung in there a bit longer. If you guys could just talk a little bit about the process of determining when to exit. So in terms of exiting, I think it's really when the market is ready for this. We've exited with our two suture anchor companies, we exited after we had obtained 510K clearance. And then with a shoulder brace that I designed, we actually had to put this on patients and show that there was some sales traction. In the current company that I'm working on, which is for AC Reconstruction, there seems to be more of a question of A, making sure that they're good clinicals, and then also people want to see market adoption, because it's not such a big market. And I think with the larger the market, the more people are willing to have an earlier exit. I imagine the bigger the group that develops, the more minds come into that decision-making. Exactly right. Yeah. Steve? So my answer is, you exit when, simply, somebody wants to buy your company. So when somebody offers you a deal that you can't refuse, don't refuse it. Take your gains. But if, you know, we went to the companies. How many times, Mike DeVries and I, my venture capital partner, and the big companies want us to use their implants, but they didn't want to buy. So we grew, grew, grew, grew, grew. And then at some point, when we hired iBanker last year, then COVID hit, so now we raised money and we're doing great again. But you know, the pattern goes up and down, and up and down, and up and down, and you think you're about to sell. That's the thing I learned from my life. Just because you think you're about to sell doesn't necessarily mean a whole lot until you sell, you haven't sold. And all the money you've invested is still there, it's still out there on the Ethernet. So when you get a great option, you might want to have a look at yourself and sell it. But if you don't, and you can afford to keep going, keep going. Right. Questions from the audience? Yeah. So this is obviously a risky sort of business, and our practices are well to be seen, and So, you know, it depends, I mean, it depends how aggressively you want to jump in. I mean, with my company, you know, I think about it a lot, I probably spent an infinite number of hours researching and brainstorming and things like that. But it's fun, actually, I do it late. I'm a night owl. I mean, I don't know, I think a lot of us can work long hours and not need much sleep, and it's probably not good for overall health. But I'm one of those people. So I spent a lot of hours, after hours, and after my kids are in bed, whatever, initially. Once you actually found the company, and you have a team, I mean, you need to make commitments during the day, right? So I actually had to throttle back my practice, change the way my practice operates. I have a number of PAs who are extremely helpful for me, and allow me to still get the volume of patients through my office, you know, meet the demand there. I mean, maybe not quite, but we're, you know, you got to at some point, you know, jump off the cliff and say, hey, I'm going to just work a lot harder than I'm used to working, and you got to make some sacrifices. I mean, it's that simple. But a lot of stuff, I mean, I think, again, we're conditioned to work a lot, basically. And so when I talk to people, and they say, well, you know, are you going to ever quit your day job? It's like, yeah, at some point, I probably will. But I mean, I think we, I mean, I'd say I have two full-time jobs. I put 40 hours a weekend in both my jobs, more than 40 on both of them, honestly. But that's just what I've always done, right? And so it's, it just is what it is, right? If you want to succeed, you got to just, you got to do it. And you can start slow. You can spend a couple years kind of screwing around with it, and doing research, and find a software developer, in my case, or a prototype, if it's a device, and, you know, put in a provisional patent, and, you know, bounce the idea off folks, I think, and, you know, you can, that's what I did for a few years, a number of years, before I was like, okay, I think I'm ready to go, and then boom, got to just jump off and do it. You know, I think one thing that, one thing is that you're sort of, you're using a slightly different part of your brain when you're doing this. So if I had to see, you know, 16 hours of patients straight through, I'd be exhausted. But the fact is, you know, you see patients, and then you're working on something that's very creative, or you're working on, you know, managing, you're working on biomechanics. And so it's sort of, you know, you sort of, you know, and part of it is, I think, we're all influenced by our mentors. So I would see people who would, you know, do full-time clinical practice, and then Steve here would, you know, run to do, would, you know, run to work with teams, and then do research. And that's sort of the thing that you're doing, you're sort of compartmentalizing. And it makes, you can work incredibly long days, but it just, it doesn't seem like it, and it becomes very engaging, and it's real, you're working on something that you really love to do. And what a lot of entrepreneurs will say is, it's sometimes the most exciting part of what they do. And I think one of the things that I noticed when I first got into practice is the people who just focused on their practice, after a while, it got a little burnt out. I mean, they, you know, they, because they knew what they were doing. This forces you to grow the whole time. And you know, at one point or another, you may not be taking as much call, you may not be the most productive person in your group, in terms of bringing in revenue, but you're really engaged. And more than anything, you're moving, you're moving the field forward. You're making a real contribution to orthopedics and to patient care in a much larger way than you do as in your practice. So I'll add another thing. I think it was a great question. And I think that the answer to that question has evolved over the years. So back when I first started doing device development, the, it was much easier to license your ideas. You could go to a big company, they were much more receptive. Today, they're looking for a more fully developed idea. They may want to buy a company. So the process has changed. And I think stay tuned, there, myself and a group of others are looking to try and develop a program where we might be able to help guide surgeons to maybe take some of that risk away, take, help to guide through that process, so that maybe you don't have to spend as many sleepless nights as some of these guys have done to develop their companies. But I think it's a great question. It's been a changing field over the years. Any other questions from the audience? I'm going to point out something that fits into your question, too. I was with Nat during this project, and just to let you know, I think Nat, at the peak, you had how many different startups? Three simultaneously. Exactly. So Nat was with three different startups, full-time practice, and some of his peers in this group that have been working for local doctors together. So I think Mike's project is different than a startup, and some of the other startups, and how much time. So I don't think all of these are 40-hour workweeks. I think some of it's an email during joint patients, and another email at lunchtime, and at 7 p.m., phone call, and Zoom conference. So it does vary. It is Google. It is Google. I mean, it is a great site. Let me just add one thing. I second everything that they just said. For me, it keeps me healthy, because I love the creative process. It just makes me happy. So the other thing is, everybody gets burned out with the EMR. Everybody gets burned out hearing a patient complaint that, like, you saw them, and they're scapulous, or you didn't listen to me, and I don't want to pay for PT, when you gave them, like, a whole protocol of what to do. So we all need these other interests. So whether it's, like, tennis, or skiing, or when I was teaching at UCSF, I spent all these night hours writing papers and presentations and everything. Some people love that. You see people running around. All they do is present all over the place. Well, this is just a different form of that. So if you love the creativity, you can do both. And you don't have to give up your life. And one other thing is, if you have a great idea, you might partner with a group of experts that can help you do that, so you do 10% instead of 40%. So even though my company is, like, worth over $100 million now, I don't do much for it right now. It's taken off. Like, the CEO has it, and the engineers have it. So I don't spend that much time on it anymore, actually. Where do you find those partners? Carefully. Yeah, carefully. Thoughts, Nat, how have you found partners to partner with and help you with your engineering and business side? I mean, living where I live, I've been actually very lucky. And I think what happens is that over time, then, you end up developing networks. And I think in terms of engineers, again, there are a reasonable number of medical device engineers out there. I mean, when you sort of talk about taking risks, these are people who are working full time on your idea, and often on very, very limited salary, because they're taking more equity. So that's one of the things that it makes you realize, you better make sure that your idea is a pretty good one. And again, I think this is something where part of being the Orther founders is that as we grow this, we'll have more opportunities to say, these are people who are looking for work, and we can help out with that. So I think there's a real power in that. Okay. Any other questions? All right. Well, I appreciate your time and attention. I apologize that we've run over. And if you have any other questions, I think the guys will be hanging here for a bit. And enjoy the rest of your meeting.
Video Summary
In this video, Nat and Steve discuss the process of determining when to exit a business. Nat emphasizes the importance of market readiness and obtaining regulatory clearance before exiting, while Steve believes it is about accepting a deal when someone offers to buy your company. They discuss the factors that influence the timing of an exit, such as clinical viability, market adoption, and the size of the market. The speakers also share their experiences and offer advice on balancing entrepreneurship with clinical practice, finding partners, and managing risk. They highlight the creative and fulfilling aspects of entrepreneurship and the potential to make a significant impact in the field of orthopedics.
Asset Caption
Nathaniel Cohen, MD; Stewart Gitler, JD; Stephen Gunther, MD; Michael Havig, MD; Raymond Thal, MD
Keywords
exit strategy
market readiness
clinical viability
entrepreneurship
orthopedics
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