Ruthless Prioritization and How it Can Help Every Medtech Startup: Interview with Paul Buckman, Former CEO of Conventus, SentreHEART, and Pathway Medical Technologies


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A few years ago, I had the privilege of sitting down and talking with serial medtech entrepreneur Paul Buckman, who at the time, was CEO of Conventus Orthopedics

Prior to Conventus, Paul held CEO roles at SentreHEART, Pathway Medical Technologies (which sold to Bayer HealthCare), and Devax (which sold to Biosensors International). From 2004 through 2006, Buckman served as President of the Cardiology Division of St. Jude Medical. 

Before joining St. Jude, he served as Chairman and CEO of ev3, a company that Buckman co-founded and was later acquired by Covidien for $2.5 billion dollars in 2010.

Paul has worked in the medical device industry for over 35 years, including 10 years at Scimed Life Systems and Boston Scientific, where he held several executive positions before becoming President of the Cardiology Division at Boston Scientific in January of 2000. Buckman received a BA degree in business administration and an MBA degree from Western Michigan University. 

Interview Highlights with Paul Buckman

  • Of all the medtech startups that Paul’s been a part of, the two that are closest to his heart.
  • Two of the many key learnings that Paul recalls during his time helping to build Scimed.
  • When it comes to product development for medical device startups, why it’s critical to be ruthless about prioritization.
  • Paul’s rationale for making the leap from president of Boston Scientific’s cardiology business to starting ev3 in the early 2000’s.
  • Paul’s approach to turning around medtech startups that have hit a wall.
  • Paul’s advice for raising capital for medical device startups.
  • Paul’s favorite business book, the CEO he most admires, and the advice he’d give to his 30-year-old self.

Read the Interview with Paul Buckman

Scott Nelson

A few years ago, I had the privilege of sitting down and talking with serial med tech entrepreneur Paul Buchman, who at the time was CEO of Convinces Orthopedics. Prior to convince his Paul held CEO roles at a variety of startups, including Pathway Medical Technologies, which sold to bear healthcare, and D Backs, which sold to Biosensors International. From 2004 through 2006 Paul served as president of the cardiology division of ST Jude Medical and prior to ST Jude, he serviced chairman and CEO of E V three, a company that Buckman co founded and was later acquired by Comedian for 2.5 $1,000,000,000. Yet it's a 1,000,000,000 with a B that was back in 2010. Paul's worked in the medical device industry for over 35 years, including 10 years at Simon in Boston Scientific, where he held several executive positions before becoming president of the cardiology division at Boston Sigh in January of 2000. As you can imagine, we covered a wide variety of topics in this interview with Paul. But here are a few things that really stand out of all the med tech startups that Paul has been a part of the two that are closest to his heart. Two of the many Keeler rings at Paul recalls during his time helping to build Simon before Boston Scientific later acquired a company. When it comes to product development from med tech startups, why it's critical to be ruthless about prioritization in Paul's personal rationale for making the leap from president of Boston Scientific's cardiology business to starting evey three in the early two thousands. We're gonna cover a lot Maurine this interview with Paul, which I'm sure you'll enjoy. But before we get to it. A few quick messages If you're new to the Met cider interviews or if you want to follow along, head on over to med cider dot com. That's M E D s I d e r dot com, and you'll be able to do two things. One is you'll see an archive of all of the previous Med Center interviews that I've recorded over the past got close to 10 years, so feel free to peruse those in your free time on then. Second, you'll have the opportunity to enter your email address, and we will not spam you. Rest assured, that won't happen. In fact, the only time you actually hear from us is when a new interview goes live. So head on over to med cider dot com and enter your email address there and then. Lastly, it's been a couple of years, really, since I've dusted off the podcasting Mike, if you will, and that there's a reason for that. I've been knee deep in my own start up over the past. Guy should spend almost four years, I think, 4 to 5 years now, since since initial inception, have learned a ton as as you can probably guess, and if you fall along with these interviews, I'm sure I'm sure we'll be sharing even Maur insights. But if you're interested in and that particular startup, head on over to juve dot com j two O's to these juve dot com We manufacture and commercialized light therapy devices direct consumer photo by a modulation, as academic researchers like to call it. But that's juve dot com if you want a little a little bit more about what I'm up to these days. So without further ado, let's get to this phenomenal interview with Paul Buchman. Paul. Thanks for joining the Med cider program. Appreciate you coming on

Paul Buckman

my pleasure.

Scott Nelson

All right, Paul, you've been a part of several med tech startups that have gone on to a successful exit. Simon E. V. Three Pathway, et cetera. That this kind of goes on and on. It's probably like asking which of your kids do you like the best? But is there a favorite that comes to mind or one that really stands out? As you look back at the at the arc of your med tech career? You know, that is

Paul Buckman

a hard question. Scott I'll tell you that I probably learned the most about building and managing a high growth company while I was Simon, which was in the most of the decade of the nineties. That was a great opportunity for me. We had a stellar group at Simon of really competitive people, and the company culture that had been developed there was developed around high performance and high growth. So it was, ah, interventional cardiology company. It was a terrific time to be an interventional cardiology because the market was taking off. It was really exciting part of the med tech market, and Simon was not the biggest player. We were kind of number three. I would say. Maybe when I joined maybe even number four, I can't remember. But it was very dynamic markets, and I just learned a lot about you know how to manage and build a high growth company. And Simon had such good people on such good leaders and such a good culture that it was a great place for someone in my position, coming out of mostly a sales background to learn a lot about the you know how to do that on the inside of a company, and Simon was clearly a stale, driven company. But we were also product development driven because the interventional cardiology market was a product, almost horse race, you could call it, You know, every company. Uh, it was a race to see who could come out with the next generation product, the next generation of a product. And it was truly a race the market share into market leadership. It was so fun to be in that because Simon had this competitive nature to it and kind of a take no prisoners attitude, that it was just really fun. And we grew a tone. I would say, in the nine or 10 years I was there, I think we went from probably less than 100 million in revenues to almost two billion in revenues just in

Scott Nelson

that window of time. I think

Paul Buckman

it was like eight years, nine years. So you learn a lot about operating in a company that's growing at that raid, and I probably learned more there than I did any place, so that's hard to leave that one out as a favorite.

Scott Nelson

But then,

Paul Buckman

you know, evey three also has a special place in my heart, too, because E V three was just a really unique opportunity. And it was the first time I had ever been involved in a company literally from scratch, where I was like the first person for the first employee in the first person to come in and lead it. And that really stands out because not only was it a unique experience, but it maybe was the hardest job that I've had. You know, Evey three was, I don't know how much you know about it, but it was a situation where we aggregated essentially a lot of very different early stage companies together in a really short period of time. While we were simultaneously attempting to build a strong corporate culture that would sustain a high growth vision Over time, it was. It was a venture that was done in partnership with Warburg Pincus, which is a very large private equity firm out of New York. At that time, I would say they probably had around 25 billion under management, and they were interested in doing what they termed a cardiology roll off. And they had Dale Spencer, who was the original CEO of Simon and who I had worked with at both Simon in Boston Scientific and who was a bit of a mentor to me. He was working with Warburg as a consultant. He had basically left cross and scientific semi retired, was working as a consultant with Warburg, and they wanted him to lead this cardiology roll up. Dale decided that he really didn't want to go back into being a CEO. So he told Warburg. He said, Look, I'll be the chairman of the board and I've got just the guy for you to be the CEO and to run to build this thing And so he came

Scott Nelson

to me at

Paul Buckman

Boston. I had only about a year or so a year and 1/2 earlier, then promoted to president of Sauce and scientific cardiology, which was by far the biggest division. And it was a great opportunity for me, and Dale came to me and he said, Paul, I would not ask you to leave an opportunity like that if it wasn't for something really special And he said, You know, these kind of opportunities are once in a career Opportunities toe not only build a company from scratch to be able to do, but to be able to do that with hundreds of millions of dollars of capital committed to back you up and do it, he said. That just doesn't happen very often. And he said, I think it would be a terrific opportunity and you're the kind of guy that we need to do that. So I went out and met with Warburg and talk to them about their vision and what they were their expectations. I talked to a few of other people that, you know, I kind of rely on for advice and decided to take the plunge and do it. I did persuade Warburg and Dale that it might make more sense for us to not limit the venture to just cardiology, but to expand that a little bit so that as we invested in technologies and therapies that we could maybe leverage them across different clinical opportunities in the vascular space and therefore maybe get a better return on those investments, which is a small early stage venture we needed to be able to do. We didn't have the wherewithal of the big companies, even though we had a lot of capital behind us. So we morphed. What was going to be a cardiology roll up into a vascular roll up, which included neural, vascular, cardiology and powerful vascular. And that's

Scott Nelson

where the

Paul Buckman

E V three came from. Three different pathways of endovascular therapy

Scott Nelson

got it that such a good story member remember Paul caps in her, mentioning That's where the three and E V three came from because I think a lot of people don't realize they think of the three is either a neuro or peripheral vascular company, and they forget that first started as a cardiology company. So that's that's interesting that you call that as well. Yeah,

Paul Buckman

that's right. And, uh, speaking of Paul, you know, Paul was probably, I think, the third employee of the company. It was myself and Stacy ending, saying and then Paul capture. We all work together at Boston Scientific and Simon and we really were the 1st 3 employees of the company, and we came in all his consultants really to begin with. We haven't informed the company yet, and so it was that early stage that early of a stage company and we were literally on the fly building strategy and the plan to execute. And so that made evey three also a very

Scott Nelson

unique

Paul Buckman

opportunity that's close to my heart because it was a wonderful experience. Toe have to do every aspect of the business creation in the business development, and I didn't really have the experience at that point to do all that. A lot of that was coming at me, brand new and coming at all of this brand new. And so it was a huge challenge from a career standpoint as well for all of us, and therefore it was a great learning experience, So it's near and dear to my heart.

Scott Nelson

But I bet I want I want to circle back around and ask you for a little bit more detail in regards to you know what sort of your mindset at the time making a leap from a very good position, I think from anyone's perspective that, you know, is the president of Boston Scientific's largest business unit in cardiology to a well funded but you know, very, very small company and E V three. So I want I want to get your take on that. I think there may be some people listening that are in somewhat similar shoes, and I wanna maybe take that leap but on and probably are interested in getting your getting your feedback on that. But let's save that question because I do want to set the stage for people that are a little bit unfamiliar with your background. I provided an intro to this interview, but you're currently the president CEO of, of convinced us. Can you first kind of give us an overview of your of your device as well as maybe the problem you're trying to solve for on, then maybe give us a little bit of, ah, better picture for where convinces, Is that in regards to your regulatory clearances and commercialization? Yeah,

Paul Buckman

sure. So convinced this is the co founders of Convention. This orthopedics are a couple of engineers that I worked with think you medical who I thought were just terrific engineers, terrific guys to work with, and I really enjoyed that. They basically ran a skunk, works for us. It's ST Jude and did a really terrific job at it. And so when they decided to leave ST Jude and start a company, they asked me if I would help him do that and I said, Sure, I'd love to. And so we you know, they had a few different ideas for medical device therapies, and they went out and started kind of testing their hypotheses on those ideas. And the one that came back that seemed to have the strongest opportunity was this implantable knight in all self expanding Knighton Hall cage that would be used to repair bone fractures. Uh, basically Perry articular fractures at the end bone. And because these guys had a lot of expertise with Knighton Hall specifically and in medical device design and development, you know, more broadly, I thought it was, ah, good opportunity. And so I decided to help them raise their initial Siri's a funding and join their board of directors from the very outset. So that was in 2009 and, um, I went to a couple of friends of mine who were in the venture business. One was Dan Cole, who I worked with it Edwards and Simon and Boston Scientific, and he was running spray ventures at the time. I also went to another friend of mine by the name of Keith Grossman, who was working for ah TPG Biotech, which was a large venture firm for a private equity firm, and those two knew each other well. So I said, Would you guys be willing to come in and partner on this together and put the early money in? And they agreed to do it? They met the two co founders and really like them, Paul Hendrix and Mike Brendsel. And so they put in the initial $7 million of funding and we were off to the races. And basically the board of directors was myself, Dan Cole, Keith Grossman and then the CEO who was Paul Hendrix, one of the co founders. And that's how we got started. You know, late, later on again. This was a situation where convention later on it took them three years to get their initial 5 10 K clearance with the U. S. FDA, and that was significantly longer than we had funded the company or and it had anticipated. So as you might guess, the company ran out of money and they still didn't have their FDA clearance so nobody else would invest, and one thing led to another, and Paul was who was the first time CEO technical CEO, cofounder was having trouble getting the money raised because a lot of venture funds I don't like to invest in first time CEO. That just happens. It's nothing against him personally. They just happened. So the board asked me if I'd come in a CEO and take over, and I did. And we ended up recapitalizing the company, bringing in new funding and moving forward. And then we actually were able to get a number of regulatory clearances in succession. We now have, I think, Well, I think Career four were only concentrating on to one is in what's called the Distal Radius, which is the risks, and the other is in the proximal humerus, which is in the shoulder. Then we also have the approximate radius, which is the elbow, and we have the proximal and distal ulna. So we technically have five FDA 5 10 K clearances. But we're really only focused on two of them from a market standpoint at this time. So

Scott Nelson

that's that's what the company has. It's

Paul Buckman

a very unique and differentiated technology, and it has a number of advantages over the current standard of care, which would be metal plates and screws, and you know the challenges going out and getting orthopedic surgeons who tend to do things the way they were trained to do, um, with the products they were trained to do him on. So, you know, it's a bit of a process getting people to change how they practice and to use a new technology that looks and acts completely different. But at the same time, we've been able to show that the technology has a lot of benefits over the existing standard of care. And slowly but surely, people are starting to convert to the convention cage because the clinical results are just better, and that's been very exciting to see. It just takes a long time to do that in orthopedic surgery

Scott Nelson

because, no, I bet you're, uh,

Paul Buckman

do everything the way they're trained,

Scott Nelson

I bet. I bet you're You're used to probably playing in the interventional vascular space where, you know, most physicians would naturally gravitate towards lower profile, less invasive device or therapy where, as you know in the orthopedic space, don't want to cast a too broad of a blanket here with my statement. But, you know, they're used to, you know, opening someone up and having no problems with it, you know? So I gotta think that's probably a decent challenge to try to try to tackle their inventors and what you guys were doing.

Paul Buckman

It is, in fact, what I've told people for over and over is that what orthopedic surgery needs is the orthopedic, the interventional orthopedist. You know, someone

Scott Nelson

who's going to convert surgical

Paul Buckman

procedures to perk you Tania's procedures, because that's exactly how the interventional cardiology market came to be and grew so fast because they were taking procedures and patients away from the cardiac surgeon. And,

Scott Nelson

you know, in

Paul Buckman

the case of orthopedics, if there was a specialty like that, that was a threat to the current orthopedic surgeons. You'd see a different adoption profile, but because it's the same customers in the same users, they don't need to change what they're doing. And you know, if you're trained to open people up and do things surgically and with an open procedure than than migrating to a less invasive close procedures, you know it's a big jump for them, and it happens slowly and you have to have a lot of data and a lot of experience and a lot of peer pressure before that starts to happen. But it is happening, and I think convention has a really good technology and a good solution for these kinds of fractures. And so that's how convention, you know, has evolved a better. Like I said, they've been around since 2009 and it's ah, really wonderful group of people at the company, really strong technical development and operations team, really good regulatory clinical group. It's just a strong, strong organization for a small company, and they've done done a really good job, I think

Scott Nelson

great. Well, I I certainly would encourage everyone to toe wobbling old into it in the show notes for this particular episode. But check out convention because it definitely is an interesting take on orthopedic surgery, for sure. So let's take this opportunity to kind of step in what I call the Med Cider Time machine and kind of learn a little bit more about your your earlier career in med tax. So you mentioned earlier your time with Simon and how valuable that was from a just a personal or professional development standpoint. I think you mentioned you spent about 89 10 years or So, you know, from the early days of side man leading up to the acquisition by Boston Scientific, Probably experienced way too much for, you know, a 45 minute or our long discussion. You know, to really go too deep with that. But are there certain a few things that really come to mind? Maybe one or two that stand out, that really you still hold? But you still look back on even today, that were really valuable learning experiences during your time at Simon.

Paul Buckman

Yeah, absolutely. Um, there's a few things that I I feel like I learned a lot about. I mean, from a business functional perspective, fine background and history was always failed in commercial. So that's what I knew the best. I would say, I you know, I had a long sales career and marketing and all that kind of stuff, and Simon was really good at both of those. And so I I learned from a lot of just really good, talented people at Simon and because the market we were in was so dynamic and so pressure packed, it was a fun time to learn. And even if you had a lot of experience in sales, you were still gonna learn new things because it it was just a brand new, different type of market. The other area I learned a lot about, though, at Simon was product development, and I include Boston Scientific. It's just, you know, they were. They became the different company after that. But product development was an area where I also thought by MIT in Boston Scientific really excelled. They had terrific engineering. They had a really good process for product development. They had very close connections to the customers and the users, and that really influenced and drove our product development priorities and projects. And what I learned at Simon in Boston Scientific was how to do really good product development that's differentiated and meaningful to the customer, but to still do it fast and at high quality. And it's easy to say, but it's hard to do because you have to be good at a lot of different things. You know, you have to be really good at being able to synthesize what customers air saying into what they really mean in terms of what is important for products, and a lot of times customers don't verbalize very well what they really want, What the what they'll typically described to you is the best product they've seen are used in the past, and somehow that will kind of come out. And what you have to be able to do as a product development team or person is to be ableto kind of see beyond that, and you can just do it in a discussion. You have to actually be in the lab or be in the operating room or wherever it may be. You have to be there watching and interpreting everything they're doing during a procedure and see where they get frustrated and see what things work and don't work. See what things could be done faster or more conveniently. And our group that Simon was so good at that, and they were so good and quick at turning those learnings into new product improvements, product iterations, new platforms. And I was just always so impressed with that, and it made it fun to be there because the customers saw it. They knew it, they wanted to work with us and they were blown away by how fast we would come out with new products all the time, and that was just fun to be part of that, because the

Scott Nelson

customers were getting so jazzed by and

Paul Buckman

at the same time, I thought we had a really good process for it because we got very good. I think it being somewhat ruthless about prioritizing everything around product development, whether it was what types of features and attributes of product was gonna have, how important those were related to every other attributes feature, how important those were relative to cost trade offs or manufacturing trade offs or quality trade offs or whatever ease of use trade offs. And our team was really good at that. And we had a process for constantly reassessing and re prioritizing every one of those elements not only for a specific project but constantly doing that for each project. Is it related to every other project that you had either active or in the bullpen so that you had this constant movement of projects and priorities and it was all driven by the return you were going to get the incremental market share you were going to get whatever and, uh, and then you allocated and all your resource is accordingly And so it was kind of, Ah, symphony of decision making that was happening on a day to day, week to week basis. And I just thought that we did that well, it was very transparent. It was very fact based, not emotion or opinion based. And people were expected to come in and be ready to either have a better solution, a better timeline. Ah, lower budget of whatever it had to move the chains. And if you couldn't do that and couldn't defend it and it didn't happen, and there it wasn't personal and it wasn't career ending or career impacting, it was just the best idea. Always one. And that's

Scott Nelson

just how the company operated.

Paul Buckman

And I found it to be an extremely refreshing environment to work in because there was no politics, everything stood on its own merits, and we always had vigorous debate over every little detail decision, and we seem to always get two good answers. And I just came out of that experience and I honestly have never I've never experienced it, too, quite that same level of success or, um, you know, being really good at it, I just haven't

Scott Nelson

experienced it

Paul Buckman

quite like that stents. And so that's what that's what really impacted me from that. And then the last thing I guess I also learned a lot of I met about International because that was the first time where I really had a dedicated international responsibility, because I spent a couple of years when it was still time it and right before we got acquired by Boston Scientific, where we have decided to convert our entire international business from distribution to direct sales. And it was a huge undertaking, and I was brought in along with Jim Corbett. I worked for gym at the time, and the two of us kind of lead that effort a worldwide to convert that. And I learned a ton about just selling globally and working with organizations from many, many different countries and cultures. And it was just a great learning experience for me and has served me well also. And that's an opportunity. I was given it. Simon that, you know, really, I think helped my career quite a bit.

Scott Nelson

Yeah, but I I think we could probably have a whole a whole discussion around things that you learned, you know, developing some of the international markets and in converting, you know, your career commercialization to a direct sales force for the sake of time. If you're okay with it, I'd love to ask you a few follow up questions in regards to couple those point you made about product development. Because I I think there may be some some anecdotes for other other folks that are listening and may be trying to improve our enhancer, optimize their you know, their product development efforts. But you mentioned something about really understanding or being able to synthesize what the customers really want. And it's just a hunch. But I wonder if that if your broad experience in sales and being really in the trenches helped you sort of enhance that ability to really try toe, translate what customers are saying to into what really matters. And, you know, I personally see it all too often that a lot of upstream or classic upstream marketers will sort of gravitate towards traditional market research when may be the appropriate next step would be really getting into the lab, as you said, whether it's the O. R. The cath lab, wherever, maybe, and really understanding, you know how these products succeeded, where they failed, you know, in the customer's hands. So what would your response be be to that? That statement?

Paul Buckman

Well, I think my sales background definitely helped me because, you know, there's nothing like having been there where you've gotta actually persuade a physician to change what they do, which they don't do that lightly. You know, they're all about patient care and patient outcomes, and so doctors don't change what they do very easily. And they have to be persuaded, usually with good arguments. Good clinical data. Ah, good clinical argument of some sort and something that's either going to make it better for the patient. Safer for the patient, faster, more economical, easier less problems, whatever. And so if you're out there and you're in these procedures every single day like you are as a sales rep, you start to understand what things matter to the physician. What things matter to the staff, what things matter to the hospital and probably most importantly, what matters to the patient and you see that day in and day out. So you start to develop a feel for the things that may be sound good on paper but don't really matter. And the things that really do matter now. I say that also, you know, take that with a grain of salt because there are a lot of sales. People who are harping on marketing and product development people every day saying, I need this. I

Scott Nelson

need that And not all of that is good

Paul Buckman

input a lot. Some of it's pretty lousy input because it's not. It doesn't encompass enough because what what product? You know what product development experts have to do. They have to take all of that in all those inputs from the customer. And that customer might be a physician. It might be a sales rep. It might be a purchasing person. Ah, hospital. And then they have to start to I trade and triage all of that input and prioritize it based on different levels of value. So, you know, a purchasing person might only care about the cost the physician cares about. Is my patient gonna do better? Are they not going to do better? Am I going to get out of this procedure 10 minutes faster so I can do another one. And so, at the end of the day I can get home for dinner at seven instead of nine o'clock. That matters,

Scott Nelson

all right,

Paul Buckman

And then it might be an engineer or a quality person that the company or a manufacturing person. What they care about is can I make this thing reliably? Can I make it in high quantity and high quality, all those kind of things? So all of those inputs have to be triaged and prioritized and waited, so that at the end of the day, the things you decide on and the things that you prioritize is important to that product represent all of those stakeholders in the process, in the right balance. And that's easy to say. It's hardest heck to do, though, and

Scott Nelson

and then when you try

Paul Buckman

to add in some level of innovation on top of that, not just using technology and know how that you already have. But now you're gonna actually invent some things to add to that, to make it even better than the customer never knew it could be. That brings in a whole nother level of risk and unknowns and things like that, and you've got to constantly be weighing all those things And then, you know, you take that and it turns into a project that has a specified budget, a specified timeline and a specified output of product. Uh, attributes. And trying to meet all of those is really challenging, as you might

Scott Nelson

guess, you

Paul Buckman

know, because you know, the more attributes you want, the more expensive it gets in the shorter the time line, the more expensive it gets. And so there's always these puts in taste, which requires constant dialogue, constant refreshing of what's important, one of the priorities. What are we committing to, um, you know, and how do we make sure we deliver that cause? The other thing you can't have is creep where you start out and say, we're gonna do X y Z, and we're gonna do it in nine months and all of a sudden everybody wants this and they want that. And now you got a project that's gonna take 15 months, and it's gonna maybe give you a couple extra things. But it's gonna cost 30% Maura and all these other things, and you know you can get out of whack very quickly if you're not diligent and kind of ruthless. and disciplined about your prioritization and and what you're willing to compromise on and not compromise.

Scott Nelson

That

Paul Buckman

makes sense, Scott. But

Scott Nelson

if it does,

Paul Buckman

it's to me. It's one of the most interesting parts of the business that I like, because everyone in the company is involved in it, and it matters what they think, what they say, what they commit to. And I just think it's a great part of the business. And, you know, I always I always shy away from companies or jobs or products where or opportunities where the product doesn't matter or it's not that important, you know, like to me going into a business where the only thing that matters is cost. No thanks. Not interested. I want to do more than that.

Scott Nelson

Sure. Yep, that's that's good stuff. My notes here on my and I have, you know, understand synthesize what customers really want. You know, if I could emphasize, you know the word really in that statement, that would be imperative. And then, you know, ruthless prioritization when it comes down to kind of some of those puts and takes that you mentioned earlier. Good stuff. So you

Paul Buckman

talk to anybody you know whether it's they see or Stacy ending, saying or Paul caps anybody who's done this. I mean, it's not like I'm saying anything that's new people. People know that, and people understand it and they respect. It's just hard to do. And when you get inside an organization that does it well, it's like it makes a mark on you. You don't forget it because you appreciate how hard it is to do it really well. And it's one of the things I liked about a lot about Simon on Boston Scientific when we became that I thought we did that really well, in my

Scott Nelson

opinion. And there's probably, you know, I'm not sure if you've heard of the term the PayPal Mafia, some of the folks that were really early involved in in Papal. You know, Peter Thiel, Elon, musk, et cetera. I almost feel like, you know, at least maybe just my bias towards Minneapolis here, but there's like a you know, a side man mafia, where there's these these cohort that you know, this group of people that experienced such cool things that Simon and were able to kind of take it to other companies, you know yourself. You mentioned Stacy Paul caps tricks enter the list goes on, but it goes

Paul Buckman

on and on on. And I

Scott Nelson

am

Paul Buckman

I'm so respectful of it because, you know, I like to look back on my career there and think, Oh, geez, I was such a major part of that. But, you know, I feel I actually feel like I was just surrounded by terrific people who made me look good.

Scott Nelson

You know, I think they made me

Paul Buckman

look better than I was because they were just It was Everybody was so good at what they did, I thought, and I felt really fortunate to be part of it.

Scott Nelson

It would be fun to go deep and almost do a series of discussions just on, you know, x X. I'm ed folks just to try to capture what what was really imperative. Important about the success there. But you know, that's that. I guess that's that's probably for another time. But for the sake of this discussion here, let's let's fast forward to your time at E V. Three. So you mentioned this earlier in the conversation. How you were recently, you know, are fairly new in your role as president of cardiology for Boston Scientific. You know, the largest business unit, I think most people would be like, Wow, you know, Paul, you three stay on a mountaintop there. But then you made the decision to take the leap. And some of that, I think, probably obviously is, is it is because of your relationship with Dale Spencer. But you know what? Walk us through. It was in your head. You had a family. I'm not sure how old your kids were at that point in time, but it seems like despite how well capitalized TV three was at that point, that's still a pretty big risk. So, you know, can you help us understand a little bit about what was in your head and how you know? Ultimately, you got to that decision. Thio leave Boston Scientific and start TV three.

Paul Buckman

Yeah, sure. Um, you know, and I'll preface it by saying, If you ask my wife, she'd probably tell you that I've always been maybe a little too willing to take on risk

Scott Nelson

instead of staying the

Paul Buckman

course somewhere. And, you know, because she's the one that's been at home with the kids trying to figure out where we're gonna live next. And where do we have to relocate to and what have you? Um, And I still sometimes look back and wonder if it was the right decision to leave Boston Scientific because, you know, I left a great company and a great job and a great team of people, and I knew that as I was leaving that it was a huge risk. And I was leaving a very comfortable place that I had been at for a long time and felt, you know, I knew everybody. I just felt very comfortable there. And so I do sometimes still look back and say, You know, should I have done that, or was that the smartest thing? I'm not one to look back, but you know, it's easy now to look back and say, If I was going to do something different, would I have done that? I don't know. As good oven experiences evey three Waas and I did walk away from ah, another great experience as well. But even three I learned a lot there, too, because the path and the pace that TV three quickly got on in terms of adding people buying companies, integrating companies, licensing technologies, trying to build a commercial effort globally. I mean, we were doing huge initiatives simultaneously with a fairly small group of people, and, you know, as an early company that didn't have a lot of history. And not only was it just difficult to do and hard work, but it was also, um it also put a lot of pressure on you. And it was, you know, you just felt you felt like he didn't have a huge margin for error, you know, because it wasn't like we had this big base of revenue, like Boston Scientific Head, where if you bought a company and integrated it and it didn't pan out quite the way you wanted it, too. Didn't really matter that much, because you had this big $34 billion a year

Scott Nelson

business and even three

Paul Buckman

when we when we made a mistake, we felt it because we were using real money. That was private equity money that not wasn't profits were using were using somebodys investment money. And, um and we were, you know, and we were doing it in this fast paced I mean, you know, we probably in the 1st 3 or four years of the company we must have acquired. Oh, I don't know, 10 or 15 companies or businesses, maybe more, and integrated them all, some of them more than one at a time. And we built ah, global sales organization as well. We had, you know, it wasn't just a US based kind of effort, it was a global effort. And, uh, and we were buying companies that many of them were either early stage or had some level of distress where we could afford to buy a company that maybe had something we really liked about it or something we thought we could make better. But we would buy it at a time when it wasn't running on all eight cylinders or hadn't achieved or prove certain things yet. And so we were aggregating all these companies that were losing lots of money, and we were aggregating him into a company that has a big company, was losing all that money combined, and we were trying to make it better. So all of these were not only integration efforts, they were fixer uppers, and we were tryingto make the technology better or make the organization capability better or get it through a clinical study and a trial, or get it through the FDA or get it through Japan or wherever we might be going. And so we had a lot of irons in the fire all the time, and it was just a It was a high pressure business, I thought, in a high pressure endeavor that you know, felt like dog years as we were doing it. To

Scott Nelson

be honest, I want to ask you a few follow up questions. Post evey three because I know you. You left there. I think in the mid 2000 spent some time at ST Jude and then later joined D Backs and then Pathway and then sent her heart. All three startups. I think, as you know, in our interview discussion, you mentioned you joined those companies as part of the board, but then later stepped in to help run those companies. So, you know, in our little time left, I guess I wanted to ask you a question about financing. But before we get there, e guess there's a pattern where you know the border. The investors ask you in your capacity to step in and take over a company and sort of redirected. Recapitalize it, etcetera. So what do you think? You know, if I had the chance to interview some of those investors, what do you think they'd say about Paul Buckman? That would say, This is why we ask him to do this. This type of stuff. This is what he's really good at.

Paul Buckman

Well, you know, part of it might be because things I'm good at or things they have confidence I can accomplish for them. Part of it, too, though, is just the fact that, you know, I was all these opportunities. I was joining boards because there was somebody people on the board, whether it be an investor for a former colleague or executive who I knew and was friends with. And so I was joining these boards amongst colleagues and friends, people I like because I wanted to be part of it. I wanted to work with them. I wanted to help the company or whatever, and so it makes it easy. Then, when you've been worked, when you've already known people and have a tracker could with them and then all of a sudden and So you're operating with him in a board level, and then all of a sudden the company runs into some challenges, and maybe it requires new executive leadership. It's not a big leap for that board to look at you and say, Paul, you've done this before and we know you. We trust you. We work together. You know, it's not like it's just a low risk

Scott Nelson

option for them to

Paul Buckman

ask me to step in and do it because they have confidence that I can. And it's a pretty easy thing for me to want to do because I want these people. I want their investments to turn out. Well, I want the company to do well, You know, usually when you're on the board, you start to get to know the management team very well. At the company, you get to know a lot of the employees, and so you start to build up a commitment to them as well. And when they ask you to come in and lead them so that the company doesn't, you know, go away or just a you know, or go out of business or fail or whatever, it's hard to say no, Even if it's not, you know, maybe the first choice you would have taken if you were out doing a job search. It's a very easy choice to make when these were real people in real friends and real colleagues that have money and career's at stake. You want to help and you wantto say, Yeah, I'll do it. Let's see if we could make a go of this And so that's what I've done And you know, my wife. Sometimes we'll look at me and say,

Scott Nelson

OK,

Paul Buckman

why can't you hold a

Scott Nelson

job for you? But

Paul Buckman

it's kind of one of those things where it's like I like doing this. I like being on boards and helping companies. And then it's very easy for me sometimes to step in and pick up an opportunity that presents itself to keep the company going. And that's you know, it's central hard. It was the situation. Well, let me start with Pathway Halfway was a situation exactly as I described where I was chairman of the board. I knew the investors. I knew that co founders well, I knew a lot of the people on the team and the company needed a change in leadership and I said, I will do that. I'd love to come in and do it and for me it was great because I already knew the management team there and it was a really good, strong management team. The board was really strong. I liked the technology, I knew the space and I thought I can easily step in and do this, so that's what I did. And over the course of about four years we raised. I went out and raised about $40 million. When I came in, we put a commercial effort together. We actually laid off about almost half the company. We had about 200 employees when I joined, and we very quickly laid off about 100 over a few months to cut the burn rate of cash. And then we slowly started getting product approvals. We started building a sales team. We started generating revenues and as soon as we got up to about a $30 million level of revenue, we sold the company to bear healthcare out of Germany.

Scott Nelson

Yes,

Paul Buckman

and then as soon as that happened during that time I was serving on the board of central heart again. And it was a situation where I knew the investors in central heart very well. And I noticed a long time and they had asked me to join the board and I was on the board. And shortly after the pathway acquisition finalized, the CEO and one of the founders of Central Heart got sick and needed to take time off from the company. So the board asked me if I would come in and be the CEO, and at the time they didn't know if he was gonna be able to come back or not. So I said, Sure, because I like the technology. I was on the board. I like the company. I said, Yeah, I'll do that. So I did that for about two years, and during that time we commercialized and I'm built a sales team, and we got revenues up to probably a run rate of about 20 million in the first year and 1/2. And then the former CEO recovered and came back about that same time. Convention was asking me if I could help them out. So the old CEO, it's such a heart, came back and took over and I left and went over to convince us.

Scott Nelson

Got in, did the exact

Paul Buckman

same thing I was again. I was on the board, exact same scenario. They were having trouble raising money. Convention was getting very close to shutting the doors. In fact, I actually was making payroll out of my bank account.

Scott Nelson

Getting the

Paul Buckman

last couple of weeks we finally calmed down. Around of money. We brought in a small group of investors, all who I knew and were friends of mine came in and we brought in about $11 million in to convince us to keep it going and keep the doors open. And then that allowed it bought us a little bit of time. And then we parlayed that into another 14 million by bringing in two more bigger investors. And so that turned it into a $25 million round. And then another couple of years after that, we raised another $25 million round from that same group, and that's how we got convention financed and and off to the races as well. Again, it was one of those things. I mean, the last place I thought I'd end up being a CEO is in the orthopedic space,

Scott Nelson

knew nothing

Paul Buckman

about it. I was just on the board, so I had jumped in with both feet and fortunately had some really smart people around me on the management team that we're very good at what they did. They understood orthopedics well, and I basically was just the leader of the pack. But they were the experts on the product in the space, and it was a fun, really fun opportunity for me to be involved with. But again, it's not one I would have probably been seeking, and I've been doing a job search. It just kind of was serendipity.

Scott Nelson

Sure, it makes sense, as you explain it, for sure. I want to be sensitive to your time and leave a few minutes for the last three rapid fire questions but specific to your you know, that trend of kind of going from, you know, the chairman of the board or sitting on the board and taking over the company. It seems like raising money has been a key aspect of turning around some of these companies and recapitalizing them, reducing the burn rates as you mentioned before. So for those listening that are not necessarily struggling per se but at that point in the life cycle of their start up, where they need to raise another round of financing or maybe raising and a round for the first time. Clearly, your network at this point your career helps you in those types of efforts. But for those that don't have the type of network that you d'oh, are there a few, you know, one or two pieces of a device that you would offer up?

Paul Buckman

Well, I would. And let's be honest, Scott. I

Scott Nelson

think

Paul Buckman

everybody's having trouble raising capital today.

Scott Nelson

Sure, not easy

Paul Buckman

and myself included. It's it's a hard thing to do. And I think the whole med tech world has become a difficult place to raise money because there's fewer venture capital firms that are investing capital and medical devices, and the ones that are have become very particular on this stage of company and the part of medicine they're willing to invest in. And so it just, you know, you end up having to talk and approach a lot of firms to be able to get anyone who might be interested. So it's challenging, and I think the successfactors, though in the investment drivers have stayed fairly constant. And to me, what those are is you've got to be seeking unattractive and a reasonably addressable market opportunity. That's one thing they're looking for. You gotta be providing a manageable regulatory pathway, in other words, of the ability to mitigate risks. In that pathway, approval means nothing if you can't get paid for the product. And so

Scott Nelson

now what

Paul Buckman

investors look for more so than the regulatory pathway is, Can it get reimbursed, or is it in a space that doesn't even require reimbursement? That might be cash only, like aesthetics or something

Scott Nelson

like that. They want to be

Paul Buckman

assured that the product and get paid for. And then I think the other one is they want to see ah, high quality management team, preferably one that's done it before. And you know, there's a theme here, Scott, and that is the investors. Even though they're venture capital investors, they're not willing to take too much risk anymore,

Scott Nelson

and so they're looking for

Paul Buckman

all kinds of ways to mitigate risk, and these are the ones that do it. You know, they have a good product, a good market opportunity and there's good intellectual property and there's a good reimbursement pathway in a reasonable regulatory line of sight. And then I think a well conceived business plan which basically means show me that you're gonna be able to get this thing to some important milestone, whether that's on the pathway to an exit or all the way to an exit that's gonna use a reasonable amount of capital to get there,

Scott Nelson

because the minute

Paul Buckman

you know, if they start seeing really long time lines are really high cash requirements. They start doing the moonwalk right away.

Scott Nelson

They just don't see that.

Paul Buckman

And so you know none of these er, earth shattering things. But they're all the things that these investors are looking for and the more of those boxes that I think a CEO can check, the higher the chance is there going to be able to bring in some money? And I would encourage CEOs to to not always just rely on venture capital. I know in today's world more and more CEOs or looking at angel investors and things like that, I would encourage people to really look the other direction and try to bring in strategic investors and maybe have a business plan that in an expectation of driving an earlier exit at a lower level of money that also requires less capital to get there and then bring in a strategic to be one of those investors. So, for example, instead of maybe thinking you're gonna develop this company and product and someday you're going to sell it for $500 million you know those don't happen as much as they used to and they're hard to do, and they usually require a lot of capital might make more sense to say, What would it take to sell this company for $75 million or $100 million? And what milestones do we have to achieve to do that? And could we do it on a really lower scaled amount of capital where we might be able to bring in a Medtronic or a Boston Scientific or a Johnson and Johnson for $345 million not even have to have nothing? You have to bring in venture capital, and that way

Scott Nelson

you have fewer

Paul Buckman

mouths to feed at the end of the day, and you might have a smaller exit, but everybody makes money. And as you know, a lot of the exits today, not everybody makes money. There might be one or two people make money and everybody else doesn't.

Scott Nelson

That's really good advice and just even listening to you articulate that. It sounds like you said, fairly basic, fairly foundational, but yet so hard to execute on, you know, to get all of those pieces right that, you know, leading up to either around the financing or, ideally, a potential expert or exit. I should say so really, really good. So I want to be sensitive to your schedule. Paul and I really appreciate you taking the time out of your day here. But if we could just get to the last three rapid fire questions, the rapid fire in nature, your answers don't necessarily have to be rapid fire. So feel free to expound a little bit if you want to, but we'll start with number one. What's your favorite business boat?

Paul Buckman

I don't know if I have a favorite Scott, but I can tell, you know, we talked a lot about product development, one of the books that I recall, that I really enjoyed, and then I still have on my bookshelf is called The Innovator's Dilemma by Clayton Christiansen. I don't know if you've ever heard of him

Scott Nelson

part

Paul Buckman

of, ah, I forget the name of it. It's a, uh, used to be called e Can't remember. It was four syllable, four letters, but it was a consulting group that focused on product development and innovation. And when I was a Boston Scientific, we actually engaged that company for a while to help us improve our product development process. And I know Clayton Christensen, I think, was one of the founders of that firm. But that book innovator's dilemma talks a lot about how to make innovation a systematic part of your product of development effort and not just kind of a eureka moment, but something that you actually build your business around creating innovation. And I thought it was a really good book, and it's a very thought provoking book and different and so to me, it's one of the ones I really remember. You know, everybody reads a lot of business books, and they all start to run together. But that was one that really stuck out to

Scott Nelson

me. That's good stuff, too, when I have actually, I've read before personally, but it's been it's been a long time, so it certainly will probably, uh, probably did that one out again. Next question is, Is there a CEO that really inspires you? Or one that's Ah, played a big influence in your life In the past,

Paul Buckman

we talked about Dale Spencer. He was important to me, and he inspired me and taught me a lot. Another guy who maybe it was because it was early in my career and I was kind of in awe of the person and I, you know, I was just a young sales guy at the time in my twenties. But I worked at Edwards Laboratories in the early days before it became Edward's Life sciences, and Edwards was part of American Hospital supply. And I was always kind of inspired by American Hospital Supply because they were such a major player in the medical supply universe. And the CEO is a guy named Carl Bays, who was an ex Marine, and he was kind of one of these guys that for a 20 some year old kid that's early in his career. In a sales job. He was bigger than life to me every time I saw him talk or present somewhere or read something by. I always got inspired by it because American Hospital was such a big machine and kind of the only company out there with it was able to take on companies like Johnson and Johnson. And then speaking of Edward's, there's another CEO that I continue to draw inspiration from, who has ties to Edwards. And that's Mike Musallam, who's the current CEO of Edward's Life Sciences. Mike and I work together side by side, back when we both were at Bentley Laboratories, which was a sister company of Edwards and Mike was the operations VP and I was sales and marketing VP and we work together. And even back then I had a huge respect and regard from Mike because you could tell them that he was special and that he had a really head for business. And I've enjoyed so much watching him succeed at Edwards and build that company into something very special and obviously create a lot of wealth for a lot of people, including himself, over that time, and yet he's maintained a level of kind of humility to me that I really admire because I

Scott Nelson

can't

Paul Buckman

stand it when executives and particularly CEOs get arrogant and start thinking that they're the reason why the company's been successful on why people are successful and they forget about all the talented people around. A Mike has never forgot that, and he's very humble. I really admire that in people, and he's one that I continue to hold, and I respect

Scott Nelson

this good comments. I'm sure he'd appreciate that, especially the notion about humbleness. You know, it's it's something that I personally appreciate, especially those that those types of levels when everyone wants Thio, give you the glory. But having the self awareness to give credit work to do. I think that's very admirable. So less question I have for you, Paul, is I'm going back in time. Is there anything that you tell your your 25 year, 30 year old self?

Paul Buckman

There's probably a few things Scott that I think about that because, you know and the reason it comes top of mind is because my kids are constantly asking

Scott Nelson

me this right now.

Paul Buckman

Two of them

Scott Nelson

are in the medical

Paul Buckman

device business, one is just a lesson I learned early in my career as a sales rep that I have always continued to try to do is a CEO is listen a lot more than I speak. People here CEOs talk enough, and I think listening is just a lot more important. If you're good, you are. Surround yourself with really smart people and the right answers will come up if you make people feel like they have the environment to share their thoughts and not be judged by it and offer their ideas. And so I think listening is a big one. I think you have to have a mindset. At least I tell myself going back, I've tried to do this, but I tell my kids this all the time is that you can't let money and you can't let career opportunities compromise your beliefs, and you can't do something just cause it's gonna get you further up the ladder or it's gonna make you more money. If you don't think it's the right thing to do or you don't think it's the right people do it with or the right environment to be doing it in. I think you have to constantly focus on just doing the right thing all the time and the money and the career and everything else will come as long as you I think, stick to that. And so I would tell any 30 year old to do that because it's easy to get caught up in. Oh, I can make more money if I do this or I can get this promotion if I do that, but it's not worth it. If you've got a compromise, what you think is the best thing to do

Scott Nelson

In my opinion, one of those things that brings true when you say it, but but so hard to do when you get, you know, so easy to get caught up in the moment. Or maybe the culture that is around you, that maybe he was a little bit more in line with that. That's a little bit more more ruthless and fosters. You know, the environment that forces you to make those those tough decisions so really good stuff. I'm glad you mentioned.

Paul Buckman

I can tell you got to just finish that. I've like real life experience having done that because I've had two or three situations in my career where I left a company or left a job because I had a major philosophical difference or of opinion with either a board or a boss or somebody like that, and at my own detriment, I laughed because I didn't want to compromise that. And, you know, I could look back. And sometimes I think What were you thinking? Why did you do that? Why didn't you just bite the bullet? But I still feel like it was the right thing to do, because, you know, if you're going to do something really well and you're gonna put 150% of your effort and hard into it, you got it really believe it's the right thing to do. And so I I mean, I personally done that. I've left some situations that were lucrative situations, but I just didn't feel like the direction I was being pushed was the one I wanted to go in.

Scott Nelson

Yep. And it obviously turned out well for you. And I know you know, leading up to this interview, did a fair amount of research and asked, you know, within my network what I should ask you, and that's one of the things that often came up, They said Paul always seems so even keel, despite what would appear to be maybe a chaotic situation. You know, maybe that's a testament to your mindset, or that you know that the framework that you operate within is that you know that attitude that I want to feel. I want my conscious to feel good, you know, after me after making this making this decision is probably one that we should all consider. I

Paul Buckman

hope that's the case. I certainly try to do that. I just Maybe I'm just not smart enough to do it any different way, because if you kind of follow your heart, you tend to not have toe think it's hard

Scott Nelson

get stuff. Well, thanks a ton for your time point. I mean, I really appreciate it. You taking, you know, about an hour out of your schedule to do this. You have this conversation so I can't thank you enough for doing that for those listening to interview. Of course, we'll link up to the Conventions website in the show notes for this episode, but until the next med cider radio interview, everyone take care

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