Thanks a lot, Ray, and yeah, thanks for coming early this morning, Saturday morning, I know it's tough, and I'll try again, kind of like Nate said, it's fairly high level, happy to answer any questions, talk after the meeting, or reach out to me by email or phone, because each of these subjects really could be a, we could do a full day of this, honestly, and hopefully at some point in the future we will. My disclosures, I founded HealthMe Technologies, my software company, and I'm going to talk about orthofounders, it's a not-for-profit support group, basically, I'm going to mention a number of innovative companies in my talk, and I'm going to do it without commercial bias, but I think it's important to talk about this, and since we're in Nashville, I've got to give a shout out to my alma mater, Vanderbilt, I'm not on faculty there, I want to claim that, but I did go to school there, and SACCO, my favorite place, great tacos and beer buckets, if anyone wants to go this afternoon and sit on the deck, I'll maybe join you. So, what are our objectives? I want to convince, I mean, I think Nate and Ray, I mean, we're all kind of saying the same thing, I mean, I want you to leave this ICL understanding that you can do this, as a practicing surgeon, so I think some of us, I mean myself, I'm sure Nate will tell you the same thing, Ray will tell you the same thing, you're busy, right, you've got your family, you've got your work, you're really working two full-time jobs when you start to do this, but you can do it, it's doable, and the great thing is there's a ton of resources out there now that probably weren't there 10 years ago, right, and you can do a lot of research. So I'm going to try and show you some of these resources, show you examples of your colleagues practicing orthopedic surgeons who have been successful at this, and really hopefully will grow this orthopedic entrepreneur movement. So why should we innovate? And these slides are somewhat repetitive, so, I mean, it's kind of funny how we all say the same things, right, but it's true, I mean, it just shows you that that is the deal. So I feel a strong about this, so when you start a company, you're a doctor, you start talking to people, and they're like, well, you're not a tech, software especially, like, well, you don't write code, like, how can you found a software company? Well, I think that's the problem in healthcare, I think it's part of the reason we haven't innovated. You know, the Code-a-thon, you know, with a bunch of 20-year-olds at a conference, and they say, figure out how to make healthcare better, and they don't know anything about it, they haven't even used the healthcare system, right? Like the people who are best equipped to innovate in healthcare are us, our patients, people who live it on a daily basis, because we're in the trenches, we see the problems, and we know the solutions to fix them, but the difficulty, whether it's a device in the OR or a software platform, is how do you take your idea from concept to company, and that's kind of what we're talking about today. And so we all complain, right? You sit around the OR lounge, we all, you know, complain about this or that, and my message is stop complaining, and there's a few steps to this. Create a vision, and then state your mission, what do you want to accomplish, right? It could be a device, it could be a software company, what do you want to accomplish? That's the key. Set a goal for yourself, and hopefully you'll change healthcare for the better, and you'll improve the lives of your patients and your fellow physicians. I want to talk a little bit about orthofounders, and again, I don't think this is a conflict in any way. This is basically a support group for innovators, founded by myself, actually a total joint surgeon here in Nashville, Will Kurtz, and Jay Crawford, who's a pediatric orthopedist in Knoxville, a med school classmate of mine, and the reason we formed this, I got a marketing email from Will's company, which was a social media engagement, reputation management thing, so I just got a marketing email, and I was like, oh, this is cool, this guy's an orthopedic surgeon, he found a software company, oh, and he's practicing, great. I called him up, and we talked for an hour or two, and he's like, you know, I know a few people, and I said, well, I know a few people, and we had our first orthofounders meeting a little over two years ago, three, six docs, and now we're over 70, we're probably 80 or 90, actually, and these are all folks that are practicing medicine. Some academic, most private practice, who have founded device companies, software companies, you know, designed new slings, done this, done that, a number of them have exited to big companies, kind of like Nate, and, you know, it's really been a lot of fun, it's really interesting. So again, where can we innovate? We talked about devices, I'll go through this fairly quickly, but these three devices you see were developed by the panelists here, you see, not me, but these other guys, right? And so you can do this, is the take home message, right? So what about software? So, you know, I think when you think about software, I mean, what most of us complain about, I think in the OR we all say, man, I could make a better anchor, I could do this better, but what do we complain about, right? We complain about office stuff, right? Inefficiencies in the OR, and these are things that software can fix, right? So I just listed some, you know, marketing, digital, social media, billing collection, electronic medical records, provider workflow, telehealth, ancillaries, staff inefficiencies, and these companies are all ORTHO founder companies, ORTHO Live, ORTHO Telehealth, Mike Greiwe, a shoulder doc in Cincinnati doing great, Nextdoc is Jay's company, ORTHONOW out of Miami is a, you know, turnkey ORTHO walk-in clinic, xScribe, Ranjan Sajdev, ORTHO Practice Management, EMR, he's got a ton of ORTHO users, he just sold to Modernizing Medicine actually in the last, this year, last few months, and he self-funded that company, started it in the early 2000s, and grew it independently while practicing orthopedics. So you know, a lot of cool stuff, OR surgery workflows, turnover times, preference cards, man, I mean, I go to this one hospital, it's like reinventing the wheel, every time I go there, what suture do you want, what cement do you want, what the, you know, it's just like beating your head against the wall, right? So there's a number of companies, Lita Williamson out in California, she's got procedure cards, Scruptec Medical's a really cool thing, Vendasa down in New Orleans, it's like a virtual, Scruptec basically, and Inventory Management for ORs, Joint Point Imaging Software for anterior hip, just exited to J&J Depew, Oxos, cool handheld, C-Arm, hand surgeon down in Savannah, Georgia, just very cool stuff that we've, you know, met, come up, you know, just, you meet these incredible people when you start doing this, it's one of the benefits. But once you've decided, okay, I get it, how do I do this, right? There's a number of accelerators, you know, I've been involved a little bit with Angel MD, and actually talking with StartUp Health a little bit, but these are, some of these will fund your company, they will help you with advisors, other things, and, you know, any help you can get is great, right? And so there's a local accelerator called Fusion Point, which isn't medically, you know, specific, but it's a local thing, and they just match me with advisors, no charge, just you have to apply and go through the application process, and that's been, that really is the thing that kept me going, right? Because I had smart people, people smarter than me telling me that what I'm doing is right, or tell them that I'm going the wrong direction, and that really helped. Then there's Physician Entrepreneur Groups, which I discovered, that have been around for a while, so, Society of Physician Entrepreneurs, Innovator MD, ER Doc out of California started that, and our Ortho Founders I talked about. But these things, you can go online, look at all these things, they're great information, they have meetings, they have resources, Stanford has great resources, I just put one up there. You can go on YouTube and talk about entrepreneurism, and you can get basically a graduate degree in entrepreneurism, if such a thing exists, but you can learn all this stuff, right? By just spending some time looking online, and our specialty societies, I mean, you know, you guys are here today, and that's great. I think getting our specialty societies to AOS to sponsor more of these innovative, you know, talks, and giving people, like, the encouragement and some tools to go forward and innovate in orthopedics. I gotta, again, I guess I may, I didn't disclose this, but we're doing a talk on entrepreneurism at the AOS this year, so if you're there on Tuesday, which tells you a little bit about the importance, I guess, AOS assigns to entrepreneurism, we're Tuesday at 1.30, I don't know if anybody's gonna even be in San Diego on Tuesday at 1.30, but we've applied for these, Nate's applied for a bunch of them, I know Ray has, and they usually turn us down, so I'm just excited after years of applying that they accepted us, and then I look, it's like Tuesday at 1.30, man, I don't think I've ever been to the academy on Tuesday, but hopefully there'll be some people there, and hopefully y'all can come, and it's been very innovative here with the innovation exchange that Ray mentioned, I was fortunate to win the pitch competition at our last meeting, and it's been a lot of fun, actually. So moving forward with software, so you got a plan, so what's next? The build and they will come mentality, I think we all know that doesn't really exist, but we all kind of hope it does, right, like, in the back of your mind, you're like, yeah, I know that's not gonna work, but my product and my idea is so good, it's probably gonna, maybe I'll be that one, right, but why not, right? Your idea, you know, and again, these are repetitive to all the other talks, it's kind of funny how much it's the same thing, whether it's software or device, it needs to apply to a large user group, you need to test the idea with potential users, the great book, Lean Startup, it's, I don't know, it's probably at least 10 years old, but it talks about this, how do you do this, and it's similar to Clayton Christensen's book, I mean, I think Eric took his book and kind of, you know, made it even, like, more specific for software a little bit, but the key is build a minimum viable product, so my first adventure in software development was around 2010, I mean, when we started developing this thing, my brother's a veterinary surgeon, and we, it's kind of the same thing, we're trying to do, like, a marketplace for healthcare, is what I was thinking of, and at any rate, with this investor we had, said, I'm too scared of human healthcare, why don't you do it for vets, your brother's a veterinary surgeon, talk to him, so we built this vet platform to sell vet services and, you know, whatnot, and we built this thing, we spent a lot of time, energy, and money, we never tested it with anybody, right, you just think, hey, everybody's gonna love this, and they did like it, okay, right, like, it was good, but you gotta, then I read the Lean Startup after that, right, someone said, read this book, and so what you do is you spend a little bit of money, you build a minimum viable product, it's something that has, you know, if you want 50 features in your platform, build it with the three key ones, right, or the five key ones, then you take it to market, right, and people are afraid to release it, they're like, that's not good enough, it's not good enough, right, but you gotta get out there, right, you gotta get out there, let your users give you feedback, and then you, and they may tell you something different than you thought, they're like, this is awesome for this function, and you're like, huh, I was thinking it was for this, and everyone's telling you it's for that, well then you basically change it, you iterate, you change the platform to meet the need of the consumer, basically, get it accepted in the market. So what's the first step, incorporate, hire a good startup attorney, right, a lot of startup firms offer packages, two grand, three grand, four grand, I hired a group out of Austin, Texas, which is kind of a popular tech center now, and I'm not really promoting them, I'm just saying if you go to this website, this guy, Jose Ansor, he's got a great just blog, if you wanna learn anything about, and tons of attorneys do this, this is how they get business, I think, they all have these blogs, but he's a really good writer, and he's got great stuff on his blog, and he can teach you a lot about how to incorporate, what's the best thing to do for a software company, IP stuff, like Stu was talking about, and then, you know, there's the Delaware C Corp, S Corp, generally it's the Delaware C, and I won't go into all this, but there's some tax benefits for an S Corp, you can write off your losses, but a C Corp, there's some, you know, basically, if you're in business for five years, and then you sell the first 10 million, or not taxable, or there's some thing that was in a entrepreneurial law that came up a few years ago, so, my attorneys said you definitely wanna be a C Corp, if you think you're gonna be around for a while, and then you have to build a software solution, right, so I think most of us, I mean, some of you may write code, or be CS, you know, grads, or whatever, most doctors aren't, right, so we are what people call non-technical founders, and I alluded to that earlier, I think that's okay, I mean, I think that, you know, when I started down this path, it was like, oh, you need a technical co-founder, it's like, I don't know, why can't I just hire somebody to do that, like, I mean, if you wanna build a car, does the guy screwing the bolt have to be the co-founder, right, like, I mean, I look at software as a commodity, it's nice to understand it, but I think that's a big hurdle for people like you all, to innovate, you're like, I don't know how to write code, everyone says I need to know how to write code to start a tech company, no, you can hire people to do this, and it's nice if you understand it a little bit, and you can learn a lot of this stuff, so you can kind of talk the talk and whatnot, and it's kind of learning on the fly, as you've heard in the other talks, but it's expensive, right, 25, 75K, probably for a minimum viable product, that's functional and works well, depending on how complex your idea is, probably need to look outside your geographic area, just like for law, depending on where you live, if you live in New York City, you don't have to, but if you live in Southwest Florida, like I do, it's hard to find startup attorneys there, right, they just don't exist, or maybe they do, but at any rate, at some point you raise money, bring your tech team in house, which we just did, and then it says build, measure, learn, feedback loop, we talked about, and again, rely on these resources for advice on who to hire for these kind of things, I'll do a case study of my company, so again, you have to identify a problem, you gotta look at the market, I mean my problem was, you know, direct pay patients can't access healthcare, and I'm presenting at the AOS this year, that 90% of orthopedic practice actually turn away self-pay patients, now all you're probably looking at me saying, no, I take cash, trust me, you probably don't, because your staff at the front desk is probably turning this business away, because you haven't bundled your services, you haven't priced them effectively, and it's not consumer-centric, where people can shop, so what we do, is we're tackling this market, and then here's our solution, right, we create a digital healthcare marketplace, we do the billing collection piece, which is a headache, that's a pain point for people, your staff doesn't like to ask people for a bunch of money at the front desk before they see you, we're marketing to grow direct pay, educating people about this, we provide pricing data, you know, I have no idea what I charge or got paid for anything I did before I went down this road, and I'm guessing if I asked most of you what you get paid for Rotator Cuff, you'd say, not sure, right, depends if it's this, this, this, or this, and so that's our biggest hurdle, honestly, like you talk about having to overcome hurdles, the biggest hurdle we have when we get a group that wants to onboard is educating them about pricing, they have no idea, nobody does, I didn't, I mean, it's still very complex and confusing, make that easy, educate staff, generate revenue for our users, our early user doing 60k a doc, so it's great, right, and it's very simple, and we're starting to see traction, so it's really exciting, and so just, then I just, I'm going to wind things up, I know it's, I know we're all running a little bit late here, but this is the process, right, so to do that company that I talked about, and still working on it, you know, a lot of us have, we're physicians, we make a good living, we have the ability to self-fund at first, right, which is kind of nice, but it adds up fast, it adds up very fast, as anyone who's done this will tell you, so you're into the hundreds of thousands of dollars very quickly by the time you do legal software, build out a basic team, sales and marketing, you know, it's, it adds up, and it puts stress on your family, right, you know, my wife used to just kind of like, oh my god, you're writing another $25,000 check to help me, and I'm like, yeah, but we're getting there, right, and now she can maybe see some, maybe it's coming to fruition at some point, but at any rate, it's a lot of money, you're going to have some of your friends and family and users, I mean, my early funding was mostly physician users on my platform, and advisors, and people close in, who understood the company well, keep the team small at first, but then you really need to expand, and when I raised a little outside money, and then expanded my team, I mean, our growth just went like that, right, and so that is a key point, like, you kind of, you got to push this down the road, you got to get it out there, I think people say, gosh, I got to do a little more work, I got to fine-tune it, I don't like the way this looks, you just got to build a minimum viable product, get it in the market, and get going. This is the second full-time job, I think you've heard that today from other speakers, it's not something you can just do on the weekends a little bit, and still, you know, have plenty of free time, I mean, I basically work two full-time jobs with this, I mean, I do my practice, I've actually cut my practice back a little bit, to be able to do more of this, as we've gotten traction, but it's a lot of work, it just is, you're always working, I mean, yesterday, I came to go to some talks, and I barely made any of them, because I kept running into people who are clients of mine, or that I know, and then you're sitting around, you have a coffee, and then you run into somebody else, and it's like, next thing you know, your day is done, right, and it just takes a lot of work. Raising capital, which we'll talk about in the next talk, very, very difficult, but kind of fun, I don't know, I've had fun at it, I mean, we were very successful in our first raise, just because it was users who were enthusiastic about the platform, but now we're raising a full-on seed round, and talking to VCs, and stuff, and it's a lot of work, and there's a whole arc to that, that could be a whole day talk, probably, and hopefully it'll scale and grow your company into a successful business, and it takes time, minimum three to five years, I mean, it made me feel good, because I've been doing this, I've been thinking about this for a long time, and then we went down the vet path, like I said, and then fell to the sideline, and then in 2016, I said, okay, I'm gonna incorporate, I'm just gonna dump some money, and get a software developer, and do this, so that was five years ago, it was crazy, it's time flies, and we're just getting traction, and in the first couple years, granted, I was not spending a whole lot of time on it, right, but it's a long time, someone told me, that made me feel better, I got sidetracked there, OpenTable, someone said, I heard this on one of these startup video things I was watching, probably, it takes, it took YouTube, or not YouTube, OpenTable, seven years, before they commercialized, right, it just took that long, before they really kind of got traction, we'll wrap it up here, device versus software innovation, they're similar, right, I think everything, software's easier, you don't have to do all this stuff here, so initially, device may be more hurdles, software seems easier, maybe, just to do off the top, at the start, but then, once you get past that initial hurdle, on device, I think then, if you license, royalties, whatever, you can have somebody take the load off, and do that, with software, no one's gonna buy your software company, if you're not making money, right, I mean, so it's a longer haul, I think, with software, and if you decide to grow your device company into a full-on company, it's the same process, right, but it's raising money, it's going through this cycle, and so finally, just to wrap it up, I mean, why do this, so we talked about how difficult it is, and I think Nate hit the same thing, right, we have some of the same drives, I got a mountain in my slide, it's climbing a mountain, right, and it's hard to gratify, it's 10,000 hour rule, I think we're all really good at what we do, we've been doing it a long time, you know, and when I talk to other entrepreneurs that are orthopedic surgeons, it's kind of the same thing, right, it's like, hey, I can do what I do, surgically, in my sleep, almost, right, it's just, it's not as much of a challenge, right, I mean, it is, but it isn't, right, you get really good at things, and you need new challenges, and so this gives you another challenge, prove the life to the docs and patients, hopefully you make a little money, and most probably have some fun, like Richard there from Silicon Valley, Pied Piper CEO, and so the good outweighs the bad by 100x, and I'll wrap it up there, thank you.

innovation

orthopedics

healthcare challenges

startup attorney

raising capital