Medical Device Approved but Still Not Getting Paid?

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0:00 You're raising money to get to this point. And then, you know, the clock just stops nobody wants to be you know that 199th person or 200 person that they're looking at that screening, right. Right? That's not even what they went to school for if anyone just talks about how they're just using AI and that's the focus. That's not what it is. It really needs to be about what I would call augmented AI, right? Let's augment it with the brain, augment it with that human intelligence.

As much as you need the right product, having that economic story is as much or even more needed, you know, in today's environment. I think it's living in that comfortable in the uncomfortable is where I have learned the most. Welcome to Zero Friction Podcast. Terry Coutsolioutsos today. And I am fortunate to have another industry veteran with me today. And one that has spanned across multiple different market segments inside the medtech, health tech space. So we're looking to get those different perspectives as well. He's also leaned in to become an entrepreneur.

He is a fractional leader across several different companies. And so welcome to have you here today, Darren Selsky. He has a consulting group called Medalytics Consulting Group LLC. And Darren, why don't you give us a little quick background on yourself personally, tell us a little bit about your company, and then more importantly, who are the people that you are designed to serve? No, absolutely. I appreciate the opportunity to be with Terry.

Personally, and by far the most important component here is to me, it's family. I'm a family guy. I have my incredible wife who keeps me going every single day and three daughters, so I have been humbled over these many, many years. And I am just a fortunate person to be where I am and to be surrounded by the love of family and the support of the family. And that's why I'm doing what I'm doing, right? That's why we do what we do, right? We do it for the loved ones in our life.

3:03 And from a business side, yeah, an industry veteran, it's hard to believe I've been in the med tech industry for 30 plus years. And my background is I started as an engineer. I have degrees in both biomedical as well as electrical engineering. And then went over to the dark side from a business perspective and have worked for large organizations. I worked in the hospital space, worked for large organizations like Siemens and Terry. That's where we've sort of our paths have crossed. Yeah, I worked for Hologic.

I worked for St. Jude Medical, which is now Abbott in the implantable cardiovascular implantable space in the implantable cardiovascular space and worked for digital health companies as well and back in 24 I just had this opportunity where an organization that I was with you know, we had a PE exit and I just had an opportunity to take a step back and say what do I want to do you know with the rest of my career and yeah I made the conscious decision that going back into corporate America yeah wasn't necessarily what I wanted to do I felt that my skills and passion I think more than anything else was to jump in and help these small to mid-size organizations commercialize solutions and bring the right solutions to market and so I put that toe in the water and fortunately I was able to take a deeper dive and things one thing just led to another and turned into other opportunities and I've just been doing this for the past two plus years and it's

Been yeah it's been a phenomenal rollercoaster and it gives me that opportunity to really diversify and to work across different segments so it's yeah so I appreciate that question that's great. And, what do you feel like you've gained and what do you feel like? Cause I've done the same thing. So you and I, you know, like you did it a little earlier than I did, but what do you feel like you've gained by becoming an entrepreneur and becoming a local expert for companies that are trying to innovate and get things to market, number one, and then I'll, then I'll ask you like, what do you feel like you've lost or maybe, you know, that opportunity of leaving big corporate America and, you know, going the other direction so what have I gained there's so much. One is I gain the opportunity to re-energize myself and re-energize that passion.

6:26 And working with these smaller organizations that are either just kicking off their commercialization activities, are about to submit and go through the FDA regulatory process, and they have just just breakthrough capabilities here whether it's true breakthrough technologies as classified by the FDA or just breakthrough opportunities to really change the dynamics in the market. These are the types of organizations I love working with and that's what I gain so much from and it's so incredibly humbling because we've been with such large organizations right whether it's with Siemens or Hologic or St. Jude Medical, these multi-billion dollar organizations. And they're incredibly process oriented and you do what you do and things unfortunately take an inordinate amount of time to get done. Whereas you, and energy and energy, by the way, oh my God, and energy and cost and so on and so forth.

I mean you work with these smaller organizations and you have a seat at the table, you make decision today and the impact starts occurring tomorrow right, and there's so much energy there and it's just it's really who I am and that's what I've learned about myself you know over these past couple years really doing this and it's just so incredibly exciting and it also gave me an opportunity to reconnect with other industry veterans and even colleagues you know who have made sort that similar leap, maybe not necessarily doing consulting and fractional work, but they've started their own company right.

And reconnecting with those folks. And fortunately, when you're in this and when you're in the industry for 30 plus years you build up a referral base and experience and expertise and just fortunate that that's helped me gain opportunities. You know, it's really, I totally agree with you that, you know, the impact that can be felt in these smaller organizations that are either getting something to market or they're single digit million dollars and they're trying to scale and get to the next level for the next round of funding or whatever the next mission is. But you're right, like they count on you and which is gonna lean me into your t-shirt real quick because I think what you and I both really cherish is accountability.

9:18 And that's yeah. Really when you're working for these smaller companies, they don't have a long list of money. They don't have a long list of people. You know, they're counting on you. And can you give me a little background on the shirt? Because it's sticking out there, like, because I said I would, and I think it's such a true statement. And I'd love to kind of lean into that topic with how we work with our customers today, of these small customers that are counting on us to help them get yeah, that next level.

No, absolutely and just a quick background and give credit where credit is due so there's actually an organization that is called because I said I would and yeah I attended the radiology administrator meeting the AHRA and one of the keynote speakers was a gentleman by the of Alex Sheen and Alex Sheen walked out onto the stage wearing the same t-shirt and I had no idea what I was walking into listening to this person and for the next hour I was just mesmerized not only by his personal story you know and his business story, but just seeing how he captivated this audience. And yeah, the statement here really comes from a promise that he made on a personal level to his father.

And he explained what that personal experience was, you know, when being with his father, you know, when his father was very ill. And it was just so incredibly relatable on so many different levels that it just had such an incredible impact on me. And then from a business perspective, as you mentioned, it comes down to accountability. And if you're doing what we're doing and organizations are relying on you to come in and helping them bring a solution to market, put the right commercial access program in place, you have to be accountable.

You have you're committing your time. You're committing your expertise and you need to deliver so that's really what it means to me and I have to live by it, right? I have to live by it every day because it is what I do you know, what do you miss about the big company? I mean, you and I both worked for, you know, we were both in cardiac rhythm mm-hmm. Management, device implants. Mm-hmm. We both worked for, yeah, arguably, like Siemens is probably one of the most brilliant IQ companies on the planet, you know, yep.

12:10 You know, so such a highly intelligent, highly engineered, highly precision organization, right? And, you know, while that precision sometimes could be really, really frustrating, but they, you know, they do make great product. What do you miss about that big, yep. A big company atmosphere? Cause I know what I miss. I kind of, you know, I want, I want you to hear and yeah, I'll share, you know, kind of like what that looks like. I think it's a couple things one I would say that resources is certainly something that I miss right because you just don't have access to those same types of resources.

And you just need to get creative, you know, with those when you're working, you know, within a team of just a few people. And it's not just me in doing what I'm doing. You know, it's really networking and, you know, working with highly skilled people that bring other types of capabilities. I work with someone who has unbelievable regulatory experience. And, you know, I leverage that person, you know, when that's a critical part of the project we're working on and leverage another person from a health economics and outcomes perspective also. So that's piece you miss.

And then the other piece you miss is the engagement with individuals, right? Either with your own team members or with colleagues and just being able to banter ideas back and forth. Whether it's business ideas or even just sort of personal stuff. Right. And you miss that engagement probably more than anything else. So, you know, today, really that occurs with the companies I'm working with, right? It's, I'm not just a third party outside contributor when I engage with an organization, I'm part of the team.

And so whether it's remote or I'm on site, yeah, you just make the most out of the time that you have in person or engaging with them to make up for that, but I would probably say it's that level of personal engagement that at least I miss the most yeah, I agree. I think the camaraderie is like how yeah, I classify it, put it in that category that is the one thing, you know, we're out here for the most part, which is making my brain kind of think about opportunities maybe, but like we're out here in our own little islands a lot of times, right?

14:53 And so, and we're all committed to the things that are in front of us and frankly as a solopreneur, an entrepreneur, like there's typically not enough hours in the day either. You know, maybe there's an opportunity where, like, you know, and especially from a med device perspective, maybe we could create a group or community where, you know, those kind of things could be, you know, we could take our like selves across the board and build a community of others and share and be successful together and kind of have that unique situation.

I completely agree and that's one of the things I try to do every moment I can is so I live in Austin, Texas. It is definitely a technology hub. Oh, Jack. It's a growing medical yeah. Technology hub and there's a lot of incubators and just becoming members of that is really important because when they do have those events you know those social events those events where they bring in speakers I try to get to and it's just an opportunity just to mingle with like-minded individuals. Yep. That's so cool.

So what are the things that you're, you know, you know, I've kind of talked a little bit about this before, when we were warming up in the green room is what are the big problems that your clients are seeing today? What are you all facing in terms of new technology introduction or scaling to the next level? Like get like the top two or three big obstacles, big friction points that, you know, seem to always be looming in there and in the way there.

Yeah oh my goodness Terry there's so many I mean market access and just a down market access it is one it's regulatory approval right we all know that especially if we're living in that type of world where regulatory approval you know is needed and the other huge one is reimbursement you know as well and I'm working with organizations that are either breakthrough or STeP and in previous world, if you have breakthrough technology, you're getting reimbursement, period. Okay. Mm-hmm. I mean, there's so many different opportunities, you know, they're out there to do that. Now, it's so much more difficult.

17:32 Okay. Or I'm working with another organization, and we just receive and we received STeP from the FDA, which is a technology program. And it's kind of like breakthrough for class for class two devices as well. And in a previous, you know, world as well, it would have been much easier to get reimbursement. Now, it's just such a difficult process and just such a lengthy process to get there because you go through the efforts of building the technology, validating the need, well, validating that there is a need in the market for a technology.

You build a technology. You engage that third party engineering firm or from you know to build it and you're putting a lot of resources you know into that pathway and then you're going down the regulatory pathway and that's an incredibly costly exercise and you would think that if you're going through that and you get all the approvals all the check boxes are checked getting to that next level you know for reimbursement because you're proving that there's a need you're proving that there's an and clinical outcomes, you're proving that there's economic outcomes associated with it.

Why should it be so incredibly difficult to get that level of support from a reimbursement perspective? And that there's just so much friction and you're raising money to get to this point. And then, you know, the clock just stops and you're like, oh, my goodness. And this becomes this incredibly vicious cycle, you know, that you're just going through to try to get there and it's just hard it's really really hard. And so I've seen this time and time again. So I think things need to change and yeah, it's it's the people.

Yeah, I think like us yeah that just keep on and pounding the pavement and pounding away and delivering these right solutions to market that something's gonna break and it's gonna give. And the implications are just beyond what's obvious as well. So, you know, you have your hard costs right in front of you where you have companies that are burning cash every day that can't afford to burn cash. They need to, and these are the things that prohibit cash from coming in the door, number one, yeah, you know, we also are going through this phase of, you know, the venture capital money, the private equity money is not, you know, unless you need 40, 50, 60 plus million dollars, those guys aren't even interested.

20:26 They're not interested in investing five or six. And so that, now you have this new category of raise in the five or six million dollar range of seed capital or series A capital to get you into the commercial phase. Now, you know, that money is like, where is it? And now you've got to go get creative with, you know, friends and family money or angel money or single or multi-family office money. And those take extraordinary efforts. They're not obvious investors. You have to go find them.

They, they don't invest for just financial purposes. They have mission and intent and purpose behind what they do. And so that's the one piece where as venture capital, they want to see you having a run rate. They want to see three, four, five, six, seven million dollars. And if these companies aren't planning the right way, that vicious cycle is like that money's drying up where they desperately need it. They've just spent, you know, two, three, four, five, seven years getting something to market through a regulatory, through a product design and a regulatory pathway, right?

And they probably, hopefully, have invested in some sort of reimbursement path strategy along with that clinical reg path, right? And that used to be the hard part, okay? Like that was the hard part. Now it feels like the hard part is when you get to market, now you get to go to commercial, and now we have this new environment. Well, it's not new, but it's becoming more tricky, is that we have this hospital value analysis committee. Yes. And so that's another like whole different set of, you know, extremity of complexity yeah. That is coming with you that will delay revenue for six, nine, 12, 15 plus months as well. So Terry, it's so funny just bringing this up.

So I am working with several companies right now that are outside the US market. And this is the number one topic, right? What do I need to do to navigate that value analysis committee, right? Help me, what's the right messaging? What do they need to hear? And so as much as you need the right product, having that economic story is as much or even more needed, you know, in today's environment. Yeah, if you're not building, yeah, if and so, you're not building an ROI next to your product, you're screwed.

23:24 Okay. I mean, you're flamed, forget it. Like you're not gonna get anywhere. Like you have to bring, -huh, if you're not bringing value to the healthcare system with your technology, man, and oh yeah, totally. Value comes in many ways. It can be cheaper, faster, better quality, whatever it is, but you're gonna have to figure out a way at the bottom line of that spreadsheet saying that my product is going to have an implication or an impact of X amount of dollars or X amount of hours or whatever it might be.

That's… it's completely right and you need to be able to bring that in an evidence-based way, you know, to these value analysis committees as well. Yeah. You need the data, right? It's data. You need to have it. It needs to be measurable. It needs to be referenceable. And that's the other thing as well.

You go through this whole process that we spoke about in terms of commercialization and bringing the solution to market. The other major expense is doing some type of a post-market study or a clinical trial, and those are incredibly costly as well. It's a combination of bringing the clinical outcomes and that from an evidence perspective and the economic evidence as well. All these are critical components of a commercialization strategy. And they've always been there, but even more so in today's environment.

That's a great topic. And I think that's a great, for the founders and innovators out there, in the audience, this is building a great product, but also making sure that you're measuring the economics behind it, because unfortunately, our healthcare system, in many ways, is totally capitalistic. So you're either gonna have to save money or help somebody make more money and have reimbursement behind it in order to get those adoptions in the right way. Just bringing something better to market is all right. No longer gonna get you there, right?

You're going to have to do other it's… things. It is, and I mean, as I mentioned before, it's making sure you got the right product. So you got to do all the discovery work, all the diagnosis of what the industry really needs. You got to experiment, and then you got to translate all that information that you learned into the right strategy to bring that solution to market. Yeah. And that's, yeah, that's my focus. That's what I love doing. Well, let's pivot a little bit. I got an exciting topic that I run!

26:04 Want to pivot on, and yeah. Something that you and I talked a few months ago about, and it's around AI. I think you and I both have spent a little time. We worked with it Siemens, which is one of the largest AI patent holders in the world no matter what category you're talking about. But you and I have been watching AI in commercial space, right? And so from your perspective, when you're looking at AI, and we can look at it from a customer, like what product offering is first.

So what do you think is real? And what do you think is BS when it comes to AI? Like, you know, like what's a real impact and what's, what is this really noise? Wow. So let me start with the noise, right? Any organization that is just talking about AI and this is how they're coming up with their results or they're improving outcomes or so on and so forth, that's noise.

Organizations that understand the value that AI can bring, but augment that with the appropriate human resources, I think is the real thing. And I can give you a couple of examples. So I was really fortunate to work for probably one of the first organizations that really leveraged AI. And that was when I was with Hologic, okay, in women's health yeah. And mammography screening. And there's no important place, I think, for AI than there.

And, but the way that they're doing it makes all the sense in the world, right? A radiologist, you know, can review 200 screenings, you know, looking at, looking for some type of breast cancer, you know, in a single day. Sitting in their dark room looking at this 12 megapixel screen. Nobody wants to be you know that 199th person or 200 person that they're looking at that screening, right. Right? That's not even what they went to school for right they went to school to diagnose you know what is different and so what we did and they've continued to do and they are incredible experts at this is being able to parse out the normals, right? And you parse out the normals and one in eight women will be diagnosed with breast cancer. And if you can parse out those normals, then allow that radiologist, you know, to really find, you or at least half of them, right?

28:56 Know, what's the problem, like take half of them and just wipe them to the side, right? Or more, it's you're looking at you're looking at less than half of them. And that's the true need for AI in medtech. Especially in imaging. Okay. I mean, imaging is just ones and zeros anyhow, right? It's all digital. So, you know, you could almost argue that, you know, a robot might be able to read an image better than the human eye in some ways. Yeah. I mean, it's the same thing.

So as I'm also working with a company in arrhythmia management and it's the same thing, right? And ECG is an ECG, but there's some imperfections, you know, that you always need just to be looking out for. And if you can rule out the normals, yeah. Then allow that expert, whether it's the physician or somebody else who has that with training okay. To identify what's wrong and then focus on that. Just focus on the stuff that's critically, but you know, that you need to look at, right? In every case you need that human involvement.

I mean I hope that we don't get to a point where all it is AI and you're really taking you know the true expertise you know which is the human brain out of the equation. And so if anyone just talks about how they're just using AI and that's the focus. That's not what it is. It really needs to be about what I would call augmented AI, right? Let's augment it with the brain, augment it with that human intelligence. Yeah, I totally agree. And I had a really interesting conversation with another founder for a company that does governance and AI integration for healthcare systems.

That's their whole job as they sit in the center of these large healthcare systems, and they help them build structure and process around how do they take the AI ideas and bring them in, and then quantify objectives, build scientific processes around measuring before and after so they can actually understand the impact. And there's some things going on with AI and healthcare. In fact, healthcare is the third fastest adopter of AI in the United States behind yeah. Banking and financial and insurance companies. Okay, so those two.

31:35 Yeah. And there's just a lot of, all these industries have tons of information that people are processing. So it's, AI has become a real data processing efficiency agent. But what they're finding in healthcare is that AI today is not saving the hospital system, any money. Okay. So there's no operational, economic efficiency that they're finding. Number one, but that's because they're experimenting and some things are working and some things aren't working. They are finding a little bit of top line improvement that AI is helping them from a revenue cycle management perspective and make sure that they're not mm hmm. Having the errors on the billing and they're getting their money faster and they're more efficient and effective in capturing the money they need to capture.

Yeah. The biggest impact, which will probably be the biggest savings down the road, by the way, is that employee satisfaction where AI is being implemented in departments is skyrocketing. So the mundane, repetitive administrative stuff that people did not get into health care to do mm hmm. Can be taken over with administrative agents and agents and workflow agents. Yeah. And now people can spend more time actually providing care and human touch. And so, you know, and people are people are sort of moving in this direction where it makes them feel more productive.

You know, physicians can actually go to bed before 11 o'clock since they're not doing work at two o'clock in the morning anymore. Is that a claim? So you know, so all these different technologies are creating better job satisfaction, which, frankly, a lot of the headcount costs in health care are due to the fact that people are leaving health care, number one, and if they're not just leaving health care, they're switching hospitals and moving around, which leaves job openings and leaves hospitals needing to pay 20, 30, 40% premiums for agency work.

And so I think what they'll find is over time, by having greater employee retention, and you'll see that there will be some OpEx benefit down the road yeah. When they're replacing, you know, 30 to 40% of their employees every other year, yeah. No, I agree. And another example is the use of agentic AI and just reaching out, just patience for reminders, right? And it's like, okay, Mr. Smith, did you your you know dot or I'm reaching out to somebody perhaps that has an implantable device we haven't seen your transmission your interrogation come in right?

34:24 Can you make sure that your monitor next to your bed is plugged in you know just little simple things like that that you can offload to an agentic to an agentic capability is also where yeah, you're going to find that and yeah, it's the tedious work. It really is. And, you know, and I'm 100% the whole, you know, because I spend most of my time designing AI and commercial workflow from a sure. Marketing and a sales process perspective. And, and I always lean on the fact that this is not designed to remove people out of jobs, right?

It really, I mean, over time, you might find that yes, there might be three or 4% savings with headcount sort of shifting and things like that, but that happens in any company without AI. What I really believe is that where the impact of AI for commercial organizations is the fact that now you can take your 100% capacity and now that person can run at 150 or 175% capacity because the, you know, first of all, intelligence is becoming commoditized with AI. So your ability to grasp information and go get it and bring it back in a very organized format is extremely high.

AI yeah. Is much more consistent and delivering consistent behavior than they can deliver over and over and over again, the same day, every day, the same way. And the other side of it is most people come to work in these big companies and even small companies, but they come to work to put a 10-hour day in with 18 hours worth of work to do anyhow. So, you know, they're never finding their way to the bottom of their pile. That pile just tends to fall to the floor over time, and you really yeah. Figure out what's important and what's not.

Yeah. No, I agree. I, yeah, there's so many efficiencies to be gained. What does scare me, you know, especially with small organizations is the information that they are uploading into these AI tools because they're putting their intellectual property, yeah, into the web, right? Into these solutions that yeah, they're learning tools. And soon as that's done, it's just using it for other prompts from other organizations or other people. And that's what worries me, right? More than anything else, when working with some of these smaller organizations, yes, we understand the value that it can bring, but let's also be careful at the same time. And that's just one of these things that we just need to be very cognizant of. You do and you just need to make sure that you use your pay subscription and you firewall your technology and you know all those kinds of things.

37:31 So where do you feel like AI from a commercial perspective? Where do you see it like adding the biggest impact for your clients, well, I can tell you how it helps me, right? So it helps me get from A to z a lot faster, okay? So I use my AI tool of choice, and for me, it's making sure that I'm asking the right questions, and then going back and refining what those prompts are, and then getting the output, refining again and again, but getting there in a much shorter period of time than I would have done a year ago, right?

Right? Or building that PowerPoint, or building that sell sheet. Those things that just take time and I would have normally leveraged a third party, right? A third party to help me build a presentation, okay? To bring that creative capability. So it saves me time and it saves me expense. You know, we're going to a third party marketing agency and it's like, here's the ideas I need. We need to build a brochure. I need to build a sell sheet, you know, for the team. It helps me get from A to z a lot quicker, okay?

Yeah. And then if I can get from a to Z a lot quicker for an organization that I'm working with, then that gives them the ability, you know, to roll this out to their sales team and let them start selling a lot quicker with the right messaging. Got it. So that's how yep.

It really helps me. And I see that sort of, they're using the companies I'm working with. They're doing exactly the same thing on their end, right? Everybody is using it, right? It's, you know, to find somebody not using AI is, I mean, we've come so far so fast is unusual. And that's the way organizations are doing it. Let's take the tedious processes that I would have had it source somewhere else, and let's just do it internally. Let's make sure we're asking the right questions, getting the right output, refining over and over again, but even refining over and over again, I get to that point a lot quicker.

Got it. Well good. Anything else you want to leave the audience with today in terms of we're sort of wrapping up our 30-minute window here yeah, I would just say the commercial process, you know, has just, I mean, it's gone through so many different changes, whether it's, you know, a result of AI and how we leverage AI to get from one point, you to the other, you know, a lot, you know, a lot faster. But as we spoke about before, you know, there's a far greater lens on what are those economic outcomes, right?

40:37 And whether it's just making sure you have the right message and the right content to present to the VAC committee. You know, it's also about what's the user experience I going to be as well. And it wasn't always like that right it's like the organizations were more in control and now you're seeing you know the customer more in control and that's I'm finding more more of my time being spent there it's like alright how do we create a better user experience okay and that's probably maybe it's because of there's so many AI tools out there and there's so much that we've done over the past you know so many years the user experience is becoming so much more important.

And then the other thing is in servicing, as well and building in servicing strategies, you know, for organizations and how do I help out the support team and whether it's helping out the support team with AI, or just helping the support team do what they do a lot better and making sure, you know, they're properly prepared with the right questions that a customer is going to call them about, you know, related to a specific type of technology. So yeah, it's, things have shifted. It's, I think it just, it's, yeah, we're just on this sort of, you know, this process improvement, you know, pathway.

And then also is like every step of the way I'm collecting data and how do I take that data and turn that data into something that's meaningful as well. Everybody wants analytics, but let's not grab data for the sake of grabbing data. Let's grab the right data and then turn that around into something that's insightful for the organization as well. So yeah, different than what we've done previously, but I think it's far more neat. It's needed and to me it's a lot more fun. Agree. And there's a couple of things that really resonated with me with what you just said. One is the whole customer experience part.

And so just simple things like you can actually buy a car in 10 clicks. Yeah. Tesla's created this whole Elon Musk, whether you love him or hate him, was like, why can I order a pizza faster than I can order a car? And so he created an atmosphere in his company, like you need to go figure out how to do a car in 10 clicks or less. And it ends up there's only two models per series, but it's done a lot of things in terms of creating.

43:19 And now people expect that experience, whether you're buying a Tesla or whether you're opening up an Apple product. I mean, you think about these companies that do that so well, right? Why can't we do it in the medical device space the same way when the box opens and it pretty much gives you the same experience, right? Why can't we do those things where, you know, and again, you and I have grown up in an implant world yeah, where, you know, if you're not there, your stuff's not getting used.

And so like, you know, the whole exactly. Rep environment is trying to stay in the OR. And I, listen, I get why that's a value differentiator. And I know that's a very controversial topic, but for me, if I'm launching a new technology, the best thing that I could ever do, right, is to have the right people promoting the product to get it sold, having an extremely elegant customer experience, startup phase and integration phase, and then having people support with, you know, stopping in and training and those things.

But you know, let's face it, the world is wanting a much more asynchronous relationship with vendors, but let's yeah. Face it, hospital systems. When you walk in the hospital, now they make you pay for your scrubs. They make you get a badge and they put a red bonnet on your head, right? So that's screaming to me. Yeah, pretty much. Like, we really don't want you here, but if you have to be here, we're going to go make it as unpleasant as possible for you, yeah, right? And so like, if you lean into those things the right way, and to me, it's kind of screaming is like, make your product so you don't have to be here.

Frankly, the companies will probably have a much better efficiency on the bottom line if they didn't have to have, you know, six sales reps running around the same hospital every day, right? We have been trying to do that for years and years, but I think we're finally at a point where we're going to see it materialize. Absolutely. Because again, if that's how you got there, most companies are fearful of like, well, what if I can't, you know, like if I can't wait in the hallway and look at the doctor and make sure it uses my implant and now the pacemaker.

Your other relationship. We would just hang out in the hallway all day long waiting for an implant. I mean, it's crazy. You know, you'd have literally like yeah. Six or seven sales reps making two, three, $400,000 a year sitting in a hallway begging for an implant. It's crazy. Yeah. Oh, well.

45:52 You know, absolutely. So anyhow, one last question for you before I go. It's a question I ask everybody. Yeah. And so I'm going to ask it really slowly because I didn't prep you for this. All right, so I'll ask it really slow. So if you have current day Darren, all right, and if Darren could go back to 22 year old Darren, all right, oh, wait.

And current day Darren can only offer 22 year old Darren one piece of advice that you have learned through your experiences in life. And it can be a personal advice, it can be professional advice, it can be financial, whatever it might be. What would that one piece of advice you would go give yourself that would provide you a much smoother pathway than you've already taken today?

And hopefully I gave you enough time to think about asking questions. So I'll throw another 15 seconds in what? For you so you can kind of, you know, process a little more. But there we go. Well, the 22-year-old, darren knew what Darren knows today from a financial perspective. Oh yeah, I would have invested in many other organizations and sure. I would have been in the middle of somewhere my own yacht but other than that honestly it's taking a risk and I think it is living in what's uncomfortable right living in the uncomfortable of doing something for yourself right and it's I guess being an entrepreneur is what really has you know sort of changed my mindset right I don't know what tomorrow is going to bring.

You know, as soon as I'm done one project, do I know when the next project's gonna be there? Not necessarily, but I think it's living in that comfortable in the uncomfortable is where I have learned the most. And it's took a really long time. I mean, being working for large organizations for 30 years before I decided to do this. Yeah, I wish I had that, you know, that different sense of risk to do something like this and that passion to do something like this.

And I guess, I mean, we have family to support, right? So that's what we do what we do. But yeah, I just finished this funny book, not giving kudos to anyone. I can't even remember what the author's name was and it was called Die with Zero. Okay. And somebody recommended this book to me.

48:45 And it's pretty much really about experiences, right? And it's kind of funny, we got the book, I put it on our kitchen island, our kids came home, they saw it and they're like, what? Right? But it's really about those experiences. And there's certain experiences that when I was 22, if I did it would have made me far more fulfilled today. Okay, because this is what this person you know speaks about and every stage of right. Your life. There's experiences that you can't do in a later stage right. We're all in this sort of go-go at some point we're gonna be in a slow go and ultimately we're gonna be in a no-go so would I have shifted that time and there would have been a more go-go for me that would have been a lot of fun.

Sure. Well, good. Well, yeah. Yes. That's great perspective and great advice, by the way. And, you know, it's been great seeing you again, Darren. Number one. Number two is I love what you're doing. I love how you're doing it. You and I will definitely have to figure out how to do more collab and work together. But I think we're both in the same boat. We both are fighting for the same kind of things and it's been a real joy kind of connecting with you again. Thank you so much.

It's been wonderful.