Medsider: Learn from Medtech and Healthtech Founders and CEOs - Ruthless Prioritization and How it Can Help Every Medtech Startup: Interview With Paul Buckman Former CEO of Conventus, SentreHEART, and Pathway Medical Technologies

Episode Date: February 8, 2020

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. Here are a few of the things we’re going to learn in this interview with Paul:- Of all the medtech startups that Paul’s been a part of, the two 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 medtech startups, why it’s critical to be ruthless about prioritization?See more...

You need to have an acceptable reimbursement pathway in front of you because having regulatory approval means nothing if you can't get paid for the product. And so now what 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 like that? But they want to be assured that the product can get paid for. Welcome to MedSider Radio, where you can look at. Learn from proven med tech and healthcare thought leaders through uncut interviews.

Now, here's your host, Scott Nelson. 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 a variety of startups, including Pathway Medical Technologies, which sold to Bear Healthcare, and Devax, 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 served as chairman and CEO of EV3, a company that Buckman co-founded and was later acquired by Cavidian for $2.5 billion. Yeah, that's a billion with a B. That was back in 2010. Paul's worked in the medical device industry for over 35 years, including 10 years at SyMed, in Boston Scientific, where he held several executive positions before becoming president of the cardiology division at Boston's science. 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 MedTech startups that Paul has 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 before Boston Scientific later acquired that company. When it comes to product development for MedTech startups, why it's critical to be ruthless about prioritization, and Paul's personal rationale for making the leap

from president of Boston Scientific's cardiology business to starting EV3 in the early 2000s. We're going to cover a lot more in 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 MedSider interviews or if you want to follow along, head on over to medsider.com. That's M-E-D-S-I-D-R.com. And you'll be able to do two things. One is you'll see an archive of all of the previous Med-Sider interviews that I've recorded over the past, gosh, close to 10 years. So feel free to peruse those in your...

your free time. And then second, you'll have the opportunity to enter your email address. And we will not spam you. So rest assured that won't happen. In fact, the only time you'll actually hear from us is when a new interview goes live. So head on over to medsider.com and enter your email address there. And then lastly, it's been a couple years, really, since I've dusted off the podcasting mic, if you will. And there's a reason for that. I've been knee-deep in my own startup over the past. Gosh, it's been almost four years, I think, four to five years now since initial inception, have learned a ton, as you can probably guess. And if you follow along with these interviews, I'm sure we'll be sharing even more insights. But if you're interested in that particular

startup, head on over to juve.com. J2Os, 2Vs, 2Vs, juve.com. We manufacture and commercialize light therapy devices direct to consumer or photobiomodulation as academic researchers like to call it. But that's juve.com, if you want to learn 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 Buckman. Paul, thanks for joining the Medsider program. Appreciate you coming on. My pleasure. All right, Paul, you've been a part of several MedTech startups that have gone on to successful exits.

SyMed, EB3, Pathway, et cetera. The list 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 arc of your med tech career? Well, you know, that is 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 at CIMED, which was in the most of the decade of the 90s. That was a great opportunity for me. We had a stellar group at CIMED of really competitive people. And the company culture that had been developed there was developed around high performance and high growth. So it was a interventional cardiology company. It was a terrific time to be in interventional cardiology. because the market was taking off. It was a really exciting part of the MedTech market.

And Simed 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 a very dynamic market. And I just learned a lot about, you know, how to manage and build a high-growth company. And Simet had such good people and 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 sales 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, it was a race to see who could,

could come out with the next generation product, the next iteration of a product. And it was truly a race to market share and to market leadership. And it was so fun to be in that because Simon had had this competitive nature to it and kind of a take no prisoner's attitude that it was just really fun. And we grew a ton. I would say in the nine or ten years I was there, I think we went from probably less than a hundred million in revenues to almost two billion in revenues just in that window of time. I I think it was like eight years, nine years. So you learn a lot about operating in a company that's growing at that rate. And I probably learned more there than I did any place.

So it's hard to leave that one out as a favorite. But then, you know, EV3 also has a special place in my heart too because EV3 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 or the first employee and 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, EV3 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 a venture that was done in partnership with Warburg-Pinkus, 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-up. And they had Dale Spencer, who was the original CEO of Symed, and who I had worked with at both Symed and Boston Scientific, and who was a bit of a mentor to me. He was working with Warburg as a consultant. He had basically left Boston 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 build this thing. And so he came to me at Boston.

I had only about a year or so, year and a half earlier, then promoted to president of Boston Scientific Cardiology, which was by far their 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 to not only build a company from scratch to be able to do it, but to be able to do that with, 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 talked 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 Warburne. 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 smaller, early-stage venture we needed to be able to do. We didn't have the wherewith all 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 neurovascular, cardiology, and peripheral vascular. And that's where the EV3 came from, three different pathways of endovascular therapy. Got it. That's such a good story. I remember Paul Kapsner mentioning that's where the three in EB-3 came from, because I think a lot of people don't realize. They think of EV-3 is either a neuro or peripheral-vascular company,

and they forget that it kind of first started as a cardiology company. So that's interesting that you call that as well. Yeah, that's right. And speaking of Paul, you know, Paul was probably, I think, the third employee of the company. It was myself and Stacey, Nzing, Singh, and then Paul, Kapsner. We all worked together at Boston Scientific and Simed. And we really were the first three employees of the company. And we came in all as consultants, really, to begin with.

We hadn't even formed the company yet. And so it was that early stage, that early of a stage company. And we were literally on the fly building the strategy and the plan to execute. And so that made EV3 also a very unique opportunity that's close to my heart because it was a wonderful experience to have to do every aspect of the business creation and 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 us 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. I bet. 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 at, you know, as the president of Boston Scientific's largest business unit in cardiology to a, although well funded, but, you know, very, very small company in EV3. So I want to get your take on that because I think there may be some people listening

that are in somewhat similar shoes and I want to maybe take that leap, and probably are interested in 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 and CEO of Conventus. Can you first kind of give us an overview of your device as well as maybe the problem you're trying to solve for. And then maybe give us a little bit of a better picture for where Conventus is at in regards to regulatory clearances and commercialization. Yeah, sure. So Conventus,

the co-founders of Conventus orthopedics are a couple of engineers that I worked with at St. Jude 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 at 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 them do that. And I said, sure, I'd love to. And so 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

night and all self-expanding night and all cage that would be used to repair bone fractures basically periarticular fractures at the end bone and because these guys had a lot of expertise with night and all specifically and in medical device design and development you know more broadly I thought it was a good opportunity. And so I decided to help them raise their initial Series A funding and join their board of directors from the very outset. So that was in 2009. And I went to a couple of friends of mine who were in the venture business.

One was Dan Cole, who I worked with at Edwards and Simet 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 a TPG biotech, which was a large venture firm or 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 liked them, Paul Hendricks and Mike Brenzel.

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 Hendricks, one of the co-founders. And that's how we got started. You know, later on, again, this was a situation where Conventus later on, it took them three years to get their initial 510K clearance with the U.S. FDA. And that was significantly longer than we had funded the company for and 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, who was a first-time CEO, technical CEO co-founder, was having trouble getting the money raised

because a lot of venture funds don't like to invest in first-time CEOs. It just happens. It's nothing against him personally. It just happens. So the board asked me if I'd come in as 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, we have, I think, three or four.

We're only concentrating on two. One is in what's called the distal radius, which is the wrist, and the other is in the proximal humerus, which is in the shoulder. Then we also have the proximal radius, which is the elbow, and we have the proximal and distal ulna. So we technically have five FDA, 510K clearances, but we're really only focused on two of them from a market standpoint at this time. So that's what the company has.

It's 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 challenge is going out and getting orthopedic surgeons who tend to do things the way they were trained to do them with the products they were trained to do them 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 actually. 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 Conventus 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 because people can't do everything the way they're trained. I bet, I bet. You're used to probably playing in the

interventional or vascular space where, you know, most physicians would naturally gravitate towards lower profile, less invasive device or therapy, whereas, you know, in the orthopedic space, I don't want to cast 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 got to think that's probably a decent challenge to try to tackle there at Inventus and what you guys are doing. 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 who's going to convert surgical procedures to percutaneous 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, you know, in 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 and 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 with an open procedure, then migrating to a less invasive closed procedure is, 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 Conventus has a really good

technology and a good solution for these kinds of fractures. And so that's how Conventus, you know, has evolved. They've been, like I said, they've been around since 2009, and it's a 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. Great. Well, I certainly would encourage everyone to, we'll link to it in the show notes for this particular episode. But check out Conventus, 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 earlier career in MedTac. So you mentioned earlier your time with Siamet and how valuable that was from a, just a personal and professional development standpoint. I think you mentioned you spent about eight, nine, ten years or so, you know, from the early days of SIDEMed leading up to the, you know, the acquisition by Boston Scientific, probably experienced way too much for, you know, a 45-minute or hour-long discussion, you know, to really go too deep with that. But are there a few things that really come to mind, maybe one or two, that stand out that really you still hold, that you still look back on even today, that were really valuable learning experiences

during your time at Siamed? Yeah, absolutely. There's a few things that I feel like I learned a lot about. I mean, from a business functional perspective, my background and history was always sales and commercial. So that's what I knew the best, I would say. I had a long sales career and marketing and all that kind of stuff. And Simed was really good at both of those. And so I learned from a lot of just really good, talented people at Symed. 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 going to learn new things because it was just a brand new, different type of market. The other area I learned a lot about, though, at SIMED was product development. And I include Boston Scientific.

It's just, you know, they became a different company after that. But product development was an area where I also thought SimeD and 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 Simead and 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 are 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 they'll typically describe to you as the best product they've seen are used in the past. And somehow that'll kind of come out. and what you have to be able to do as a product development team or person is to be able to kind of see beyond that. And you can't 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 or see what things could be done faster or more conveniently. And our group at Siamed was so good at that, and they were so good and quick at turning those learning 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 customers, we're getting so jazzed by it. Hey there, it's Scott, and thanks for listening in so far. The rest of this conversation is only available via our private podcast for MedSider Premium members. If you're not a premium member yet, you should definitely consider signing up. You'll get full access to the entire library of interviews dating back to 2010.

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