Medsider: Learn from Medtech and Healthtech Founders and CEOs - Why Intersect ENT is an Example of Hope for the Medtech Industry

Episode Date: April 26, 2013

The 2.3% medical device tax is burdensome. Regulatory timelines are long (and expensive). Reimbursement is not only decreasing, but also incredibly hard to obtain. Venture capitalists are losing interest in early stage medical device deals. Is it all downhill for medtech? There is no doubt the current healthcare environment is challenging. But certainly not impossible...[read more]Related ArticlesAre Medical Device Models the Key to Building a Lean Medtech Startup?Why Early Stage Medical Device Deals Aren’t as Bad as You May ThinkSubstantial and Sustainable – 2 Words That Medtech Companies Should Get Used To 

Welcome to Medsider, where you can learn from a mix of experienced medical device and med tech experts. These proven mentors will show you how to master the med tech space on your own terms without going to school. Now, here's your host, Scott Nelson. The 2.3 medical device tax is burdensome. Regulatory timelines are long and expensive. Reimbursement is not only decreasing, but also incredibly hard to obtain. Venture capitalists are losing interest in early. stage medical device deals. Is it all downhill for MedTech? There's no doubt the current

healthcare environment is challenging, but certainly not impossible. Case in point, Intersect E&T. The startup medical device company is well funded as evidenced by the recent Series C round of financing. They were able to get regulatory approval for a device plus drug combination product, and perhaps most impressive, they're actually expanding their sales force. In this interview with Lisa Earnhardt, president and CEO of Intersect E&T, will learn how this medical device startup company is succeeding despite the strong headwinds within the med tech space. Here are the few things we're going to cover in this interview. Can E&T companies steal the drug-alluding stint playbook from the cardiology space?

Was the regulatory pathway for the propelled device more difficult because of the device plus drug combination? What has been the biggest challenge to increased adoption of intersect's propel device? Did intersect E&T considered launching their medical devices with an indirect sales force? How important are large strategic MedTech companies in terms of providing capital for startup medical device companies? And how will MedTech companies need to change considering the strong headwinds of longer regulatory timelines, lower reimbursement figures, and changing healthcare delivery models? Of course, there's a lot more information we're going to cover in this interview with Lisa, but before we dig in, you need to listen to these brief two messages. Job leads, opportunities to network, access to specialized groups, meaningful discussion and debate,

sound interesting, then you should check out the medical devices group on LinkedIn. It's the industry's only spam-free, curated form for intelligent conversations with medical device thought leaders. Not only that, but it's the single largest medical group on all of LinkedIn. Medical device professionals worldwide are invited to join the medical devices group to help build their personal and corporate brands. Check it out. Medicaldevicesgroup.net. Again, that's medical devices group.net. As a reminder, Medsider is on iTunes. Just go to Medsider.com forward slash iTunes

and you could subscribe to the podcast for free. That way, all the new episodes will automatically download to your iTunes account. It's super easy. Also, if you like the podcast, don't forget to rate it. That really helps us out. Okay. For you ambitious med tech and medical device doers, here's your program. Hello, hello, everyone.

Welcome to another edition of Medsider. This is your host, Scott Nelson. And for those of you who are new to the program, this is a, this is a, This is a show where I bring on experienced and proven med tech thought leaders in order to learn about a wide variety of topics all pertaining to the medical device base. And on today's program, we have Lisa Earnhardt, who is the president and CEO of Intersect E&T. Prior to joining Intersect E&T, Lisa was the president of Boston Scientific's cardiac surgery division. And then previous to that, Lisa held a wide variety of sales and marketing positions at Guidant. She has extensive experience with global product launches and driving adoption of new technologies,

including implantable cardiac defibrillators, endoscopic vessel harvesting, surgical ablation, and beating heart bypass surgery. Lisa holds an MBA from Northwestern's Kellogg School of Management and a BS in Industrial Engineering from Stanford. That was a big intro, and without further ado, welcome to the program, Lisa. I really appreciate you coming on. Thanks, Scott. I appreciate the opportunity to speak with you today. Okay, so let's first start out with Intersect Ante, your devices, propel, and then Propel Mini. Let's talk about the disease state that you're trying to treat, chronic sinusitis. Can you explain what that is and maybe previous two Propel and some of the other therapies?

How did physicians treat this? Yeah, it's a great place to start. Chronic sinusitis is a condition in which patient's sinuses become swollen and inflamed, and, you know, what's most important is it leads to congestion, difficulty breathing, facial pain, a headache, along with actually reducing your sense of smell and taste. It's interesting to note, actually, the condition is quite common. It affects actually one out of seven adults here in the U.S. alone and has a big impact on patients' quality of life.

In terms of how it's treated, it actually requires what I would call a complex combination of surgical and medical treatments. So there are about a half a million patients every year that undergo sinus surgery for chronic sinusitis. And while the sinus surgery is effective, unfortunately the majority of patients experience recurrent symptoms within the first year. And as many as 25% undergo revision surgery due to recurrent obstruction in the cavity. So we believe that at intersect, we're playing a really critical role in improving sinus-severs quality of life, really across the continuum of their disease. Got it.

So just to repeat, one out of every seven adults approximately here in the U.S. alone are affected by chronic sinusitis. And then you said about 500 million surgeries per year to treat it? 500,000 surgeries per year. 500,000? Yeah. 500,000. That would be an absolutely enormous number. 500,000, which is still a relatively big number.

Okay, very good. So is there a certain sort of treatment algorithm that most physicians, use right now to treat this disease? Does it start with medical therapy and advance on into surgery? Yeah, the otolaryngologist, which is the physician community that treats the chronic sinus patients, really starts with the first line of therapy for most things they do with medical therapy. So it's a mixture of various drugs that they use, whether it be some form of steroid, whether

to be nasal steroids, oral steroids, antibiotics, antifungals, failing irrigations. You know, the list goes on and on. And their goal is really to control and alleviate the patient's symptoms first with medical therapy. When that fails, and it does, obviously, with some frequency, surgical procedure really is the next-fax option. And that's where the half a million patients a year or the 500,000 surgeries that are done each year, are really those who failed medical management. Ultimately, it is a chronic disease, so even after a patient has had sinus surgery,

the patients typically are managed for a lifetime by the E&T or the Eurnose and Throat Physician. Okay. And then those surgeries that go on right now, are they fairly invasive? And we'll talk a little bit next about your devices that you manufacture at Intersect. but the surgeries right now, are they pre-invasive then? Yeah, I mean, the E&Ts over the years, like with most procedures, have continued to introduce new technologies and new techniques to reduce the invasiveness of the procedure.

The standard procedure is done endoscopically, so it's actually called endoscopic sinus surgery, and that uses various surgical tools to remove inflame tissues and really open up that passageway. You may have heard of the balloon technology that was pioneered by a number of startups in our space as well, and now the largest company is actually part of J&J. But they basically have been a surgical tool

that's been used to open up the cavity. So just another way to do that in a less invasive fashion. Got it. Okay. And you mentioned balloon sinoplasti, companies like a Clarence that's now owned by by J&J at Intelis, which is a standalone

device company. They fall under the balloon sinuplasty. So your device propel and maybe you can speak to it right now. How is it different than some of those technologies? Yeah, I mean we I would view our technology is very

complementary to balloon technology. It really comes down to what we believe is the fundamental cause of sinusitis and that is inflammation. And so it's that inflammation that then causes the obstruction. And so with Propel, we've got a controlled release of an anti-inflammatory medication, which gets to the root of the issue.

What the balloons do, they're basically mechanically opening up the passageway, which does solve a very important part of the problem. But Propel really takes it that next step by delivering drug locally to the sinus tissue where it's needed. Got it. Okay. And I think in doing some research in preparation for this interview, I pulled out a quote, I think it's from Dr. Jay Dutton, I believe I'm pronouncing his name correctly.

He says, I'm somewhat paraphrasing here, but the delivery of drugs is an important niche in our field, and it's very important. Chronic sinusitis is more of an inflammatory disease than an infectious disease, which you pointed out there. So a big difference, if I'm hearing you correct, is the fact that, that you're not a you're actually delivering drugs versus simply opening up the nasal passages like a balloon wood in the vascular world. Yeah, absolutely.

Got it. Okay. And speaking of the vascular world, it seems like there is a fairly strong correlation. And I speak to the vascular world just because that tends to be my wheelhouse. I'm more familiar within the vascular space. So just as, you know, drug-eluding stance, you know, pioneered sort of like a whole new way within the coronary end of vascular space. I mean, we kind of see the same thing for the E&T arena

where balloons and maybe, you know, stents, stint-like devices won't just be it. It will be more like somewhat drug-eluding, you know, devices like Propel that kind of, you know, forge a whole new, a whole new trail for the ways A&T docs can treat this disease. Yeah, it is a great analogy, Scott, to draw upon is that there's obviously, you know, much like in the cardiology world where, you know, the introduction of, you know, the various balloons and wires and scents and drug-looting stents and the evolution there to a less invasive, more targeted therapy is very similar to what the old laryngology community is going to with the treatment of chronic sinus disease. So we do see some similarities there.

It's obviously a different, you know, therapeutic, you know, challenge and a different disease. And some of there's some nuances there that are different. But we do see sort of a suite of products being used by the E&P, sort of similar to how an interventional cardiologist would treat their patients. Got it. Okay. Very cool. And these procedures right now, like the standard balloon sinuoplasty procedure, for example,

is that done in an OR setting right now? Is it done more of an interventional suite? and then where would an E&T physician, where would they use like a propel? Would they do that in the same sort of interventional suite, or can they use this in like an in office or in clinic procedure? Yeah, the majority of patients who are undergoing a sinus procedure have that done in a OR setting. It typically is in the outpatient setting,

although the trend is in what we really believe the future to be in treating these patients, less and basically more cost-effectively in the office setting. And the balloon companies have, you know, a small portion of their business today and volume is done in the office setting. And we definitely see the sort of future heading there, which provides a really, it's really a win for everyone involved, right?

You know, the patient, the physician who can offer something right there on the spot. And then ultimately the health care system in that it is cost-saving. It definitely provides economic value as well as, clinical value. Right, right. Yeah, to your point, it seems like everyone wins. And we've certainly seen a large number of interventionalists, whether it's an interventional cardiologist or a vascular surgeon, you know, set up their own, their own physician-owned labs where they can, in essence, treat, you know, peripheral arterio disease in an outpatient setting. Sounds like something that we may see the same thing for E&T physicians where they can begin to treat this disease state

in their clinic or in maybe like a physician-owned lab. And like you just said, it's probably it's cheaper for the insurance companies, it's better for the patients, it's, you know, the physicians win as well because it's more convenient, et cetera. So that's, that's interesting. So in regards to that, that treatment of in the hospital versus in the clinic, what, what does the reimbursement look like for, for devices like Propel currently? Yeah, so Propel is used in conjunction with sinus surgery, so it's really treated as a supplier, probably more specifically, as an implant as part of the overall sinus surgery. Obviously, the reimbursement structure varies per each hospitals and payers,

you know, patient payers contracts. But sinus surgery is typically reimbursed as an outpatient procedure. Okay, okay. So is it, am I understanding this correct, where someone potentially could, an E&T position could potentially open up the nasal patches way with balloon sinuoplasty and then insert the propel, and we'll get into this, Propel Mini, I'm not entirely sure what the difference is between the two devices, but basically then insert Propel and then that is then sort of bio-absorable. Is that?

Yeah, absolutely. So that's a very common way in which our product is used. And Propel, just to comment a little bit about that has been proven to improve the outcomes of sinus surgery. So we're really starting first with that patient population and trying to focus on the benefits we can provide with local drug delivery. we've been able to prove that Propel reduces the need for additional surgical procedures, as well as reduces the need for oral steroids, which can have serious side effects. So obviously for patients, at least to improve quality of life due to reduction, disease occurrence, and for the physician and improve their outcome.

So it's a good, it's been a great and well-received product by the otolaryngology community. Got it. And before I get into maybe some of the challenges that you've seen to actually, because it seems like a phenomenal idea and a phenomenal device, before I get into some of the challenges to adoption, the regulatory pathway is it because you're actually releasing, because Propel, I should say, is actually releasing a drug, was the regulatory pathway more challenging then with kind of the device drug combination

versus just a standalone device? Absolutely. We are a combination product, so we work with not only CDRH but Cedar as part of the FDA, and there's also a third division there, which is the Office of Combination product. So we feel a lot of love from the FDA here. And Propel and PropelMRIME were both approved via the PMA process. Okay, okay. Got it. Okay, so back to the challenges. You've obviously explained the benefits, which are, seem to be, you know, there seem to be a lot of benefits, I should say,

to the device. What, so far, I mean, what has been some of the bigger challenges to adoption within the E&T physician community? Yeah, and I think, you know, first of all, I would say that, you know, the reception from the E&T community, as general, has been, you know,

quite positive, including the major societies. I think one of the reasons because of that is that we know that the E&T physician is really looking for clinical data to support new technologies, and I do think that's where Intersect E&T has been unique in that Propel is the only medical device that's used in sinus surgery that's been backed by Level 1A clinical evidence. And so between the clinical data, the fact that the product really is intuitive, you know,

physicians obviously, you want your sinuses open and you want the inflammation to be minimal. And so they have been trying for years to get steroid to the patient. patient's sign this is locally to no avail. And so, you know, basically just gave them what they needed. So, you know, there's been challenges, as they always will be when you're, you know, we are a new product or a new company. And so working with the various, you know, physicians in the hospitals, you know, there's a lot of startup work that needs to be done.

But generally, we've been thrilled with the rapid adoption and acceptance of the technology in the medical community. Great. And then prior to this, as I mentioned before, you spent a lot of time with guidance, a lot of your experiences in the, you know, in the kind of the cardiovascular arena. How do E&T physicians compare to, you know, cardiologists and vascular surgeons? Do they, are there similarities? Are there major differences? Can you, can you speak to that at all? Yeah, I mean, they tend to be a more conservative specialty in general. I do think they try to first address patient symptoms and disease medicine. but I would also say that prior to the balloon technology and really all the innovative

surgical techniques and tools that Medtronic released with the microdebreeder and other surgical tools that they've introduced, there really hasn't been a lot of new technologies in the space. And so unlike with cardiology, for example, where there has been a lot of investment and focused by, in particular, the big med tech companies, the otolaryngology community really hasn't had that. And so it's going to underserved market. And so I do think, you know, while they tend to be more conservative,

they're really appreciative and receptive to working with us in advancing patient care. Got it. Okay, very interesting. And I would think that, you know, startups, I mentioned to Clarenk, for example, correct me if I'm wrong, but I think they blazed a decent little trail in regards to balloon sinuplast. That probably helped. You know, E&T physicians maybe become a little bit more accustomed to a lot of focus from industry. Yeah, absolutely.

A clearing in a number of ways blazed the trail for us and many others, and were appreciative of the work that they did do and have been able to learn from them as well. Got it, got it. And I want to say, I want to ask you a few more questions in regards to the topic at hand before we get into some questions about some of the trends and headwinds that are facing the medical device, the medical device industry right now. But before we get there, commercialization, you mentioned that Propel and Propel Mini, both, you have a PMA for both devices. From the commercialization standpoint, are you utilizing a direct sales force, indirect sales force? What does that look like here in the U.S. anyway? Yeah, we decided to move forward with a direct sales force.

It's so important for us, especially early on as a small company, to develop a strong partnership in understanding of the physicians and how they see our product being used. And so we have hired a sales force. We actually started in a very focused fashion in six markets, really driving traction, developing that recipe for success. And based on that, we had made the decision to move forward with an expansion.

And so that's the stage we're in right now. So I think we have about 20 folks out in the field here in the U.S. today. Okay. And does that, you have to be, are you currently expanding your sales force then? Yes, absolutely. So we've just added quite a number, and we do plan to every, you know, periodically continue to add waves of representatives as the business dictates. So not all is doom and gloom in the world of medical devices.

You hear it here first. A medical device company is actually expanding their sales force. Yeah. Yeah. We're thrilled to be in this position, and I realize it's not common. And we've had pretty significant growth as a business, and it's fun to be in the high growth scaling mode because I know there's a different world out there today. Oh, yeah, no doubt.

And it certainly helps that your devices propel. propel many, you know, fall under the novel, you know, sort of therapy. So, I mean, that certainly helps in, you know, in terms of, you know, commercializing or justification for a larger sales force. So very cool. So a couple last questions here. I recently noticed that Cook is getting into the E&T space. That's interesting. If you maybe can make a comment about that. And then also, what's, you know, what's next for, for Internet? intersect in terms of, you know, maybe an exit strategy or is an actual public offering, sort of, you know, potentially a possibility as well?

Yeah, so I think in terms of cook, I mean, I think it's always exciting to hear of yet another company who sees the growth potential of focusing on solutions for E&T physicians and the patient. So we view that is a very good thing. The more the merrier at this stage. In terms of next for intersect, I mean, first and foremost, it's continuing to drive innovation So we just started a significant clinical program. It's called Resolve, and it's an in-office solution for patients with recurrent sinus obstruction.

You know, once again, this is a less invasive, more cost-effective solution, which really will provide a very important treatment alternative for physicians, for patients, for the healthcare system. It's one of those, you know, truly win-win-wins. And then in terms of, you know, what's next, you know, whether it's an M&A, whether it's an IPO, you know, I'm sure you're Krista Ball. is as good as mine. You know, we're fortunate to be a position where we're well-funded.

We don't need to seek additional funding. So our focus today is really building a standalone business that will deliver meaningful value for our shareholders while creating meaningful innovation for our physician customers and patients. So, you know, the majority of medical device exits are via an acquisition. And that said, you know, we're hopeful, You know, a couple years from now, there will be an IPO market for med devices and that we could be a potential candidate. Very good.

And while we're on that, this provides a little bit of a nice segue into some of the headwinds that the med tech industry is currently facing. M&A activity versus actually, versus, you know, the public market through an IPO. Do you see maybe that market opening back up in two to three years? What's your take on that? you know it's always been about two to three years out in my mind for the last five years so my crystal ball has been very foggy there yeah you know i just i think that there you know has been a dearth of of companies that have been able to to make it happen and those that have gone public have been you know i would say so so that said you know there are a number of

companies that have you know gotten to the commercial stage that are you know on the press-up of doing some meaningful things and really developing important businesses that I think are, you know, that investors will want to have the opportunity to put their money into. So, you know, we'll see what happens. I'm hopeful that the worst is behind us. Right, right. No, and I share that same hope, you know, and in fact, I recently heard a comment from a venture capitalist that focuses just on like consumer tech. And it was, I think it was actually at some sort of like half, you or something along those lines where it was actually a health care startup that, that, you know, pitched these, these VCs.

And I think this particular VC guy says something along the lines of. It's nice to see that you're not, you're actually developing something that's worthwhile, not just another app for food or for restaurants or something like that. And so, I mean, it's always refreshing to hear that, that, you know, someone else's, someone else's comments about the possibility of the public market, public market opening back up for mid-tech companies. So with that said, though, you had a large strategic recently participate in a recent round of financing. How important is it right now that large strategic seem to be,

when I say large strategics, the Cavidians, the JNJs, Boston's size, Medtronics of the world, how important is it for them to be participating in these rounds as sort of a bridge between, know, early stage series A and maybe later stage series C, series D rounds. Yeah, I think Dave, the strategics have provided a critically important source of the capital the last couple of years, especially given how the health care VCs, I would say, have taken pause. And Scratchel had someone about the current state of the state. And I think in terms of the future of the medical device industry, it's been hugely important

to, you know, maintain innovation and continuing to advancing patients. care and without the strategic investments that they've made, you know, I think it would clearly impact how we would be able to as an industry improve patient outcomes and help move the needle in terms of health care delivery. So I'm so appreciative of the investment we have in Medtronic. They came in just the right time, and they've been a fantastic partner for us. They obviously are the sort of leader in the E&T space and have a ton of experience to bear. So we're fortunate and appreciative.

Got it. And in your experience, and I don't expect you to speak on behalf of Medtronic at all, but are you seeing that most large strategics are viewing their venture arms as sort of, you know, in sort of an autonomous way. It's a separate entity. Or are they playing more of a strategic role in seeing some of these investments as future tuck-in acquisitions? Yeah, I think it varies differently. depending on the strategic and the role on their VC plays,

I think right now, given some of the challenges that, you know, sort of the big strategics are facing and some of the markets that they're in, which I would say is probably at best sluggish, they're keenly interested in identifying new avenues for growth, and some of the innovative companies like Intersect could be very interesting for them in the future. And so having a seat at the table, there's no question that's a value to them. Got it. Cool.

Let's transition to the 2.3 medical device tax. I think everyone that would be listening to this interview is familiar with this device tax and the fact that it's top line in nature. Being that you're leading a startup device company, what is your opinion of the tax? We'll start there and see where that leads us. Yeah, well, it's funny. had a meeting yesterday with Congressman Ron Kind. He is chair of the Ways and Means Committee and the House Ways and Means Committee,

a member of that actually, and has been really instrumental supporter of repeal of the medical device tax. So I've just recently spent some time talking about it. I think, you know, long and the short of it is the medical device excise tax is really short-fited. I do think there are dramatic, unintended consequences of the tax that clearly were not taught through in its creation. I do think its impact is certainly magnified by the tough financing environment that we're all facing. I mean, capital is scarce, pursuing innovation costs money.

You know, if we're spending money to the device tax, we're not spending it towards improving patient care. So, you know, I've always thought, like, at a minimum, companies that aren't profitable or companies with less than $100 million or whatever that threshold is defined as should be excluded from the tax, which I think is going to be really important to provide that relief to keep the METEC engine going in the U.S. There's a ton of headwinds, and this is just, you know, you would hate for this to be the straw that broke the camel's back. Right, right. It probably couldn't have come at a worse time. And to your point, I mean, the fact that it's top line in nature, I have failed, I've failed to come across a good rationale for that.

I just, it's, it's hard to, it's hard to wrap your mind about how, how that makes any sense, the fact that it's top line in nature. Yeah, yeah, top line versus profit, you know, and yeah, yeah, anyway, that's my perspective. So we could go on and on and on, but it's, I have a little passion around that.

Yeah, and it's, and it's nice to see, and I know, we mentioned Cook earlier. I mean, they were, I had actually did an interview maybe about a year ago with Steve Ferguson, and really about just the device tax overall. And it's nice to see that they've been very vocal, but it's also good to see now that companies like Medtronic are beginning to get a little bit more vocal

about the potential negative consequences of the device tax if at the very least it's not sort of reformed or reiterated somehow. So that's definitely nice to see. So we don't have a lot of time left. I wanted to ask you one more question, and then before I ask you kind of a final question about your background. But we've talked a lot about headwinds, you know, from longer regulatory runways, more expensive, regulatory timelines, lower reimbursement seems to be a consistent trend. What, in your opinion, are there certain things that Medtech companies can do, maybe more so early-stage med-tech companies can do to sort of face these headwinds?

And, you know, as a thought to coincide with that question, we talked about direct versus indirect sales forces. Is that maybe a trend that you'll see as more companies utilizing indirect sales forces as a way to kind of face the headwinds? Or what else maybe do you, what other ideas have you thought about in sort of in trying to grow at a time when it's rather challenging for the medical device community? Yeah, and that's probably the million-dollar question right now around the valley as, you know, as I spend time with my peers, is, you know, how do you make it happen and how do we actually get innovation into the hands of physicians? I think first and foremost is early stage is really taking a page from some of the, you know, social media and other startups we see around us is bootstrapping.

You know, how do you do more with less and be as capital efficient early on to be risk it before you put significant capital into a project. So I think that's going to be coming more of a norm, as well as looking for alternative sources of financing. And so, you know, lots of talk about non-deluded ways to finance, angel funding, you know, those types of things, just to get something off the ground. Because I don't think these are, you know,

there aren't that many D.C. who are really looking at doing Series A investors' investment, that early stage at this point. And so finding another way to move it along the pipeline is going to be incredibly important for all of us. And I think about our futures and our health care needs increase, you want to make sure we're all benefiting from sort of the best that the world can offer. Yeah, that's interesting to hear that you're obviously leading a startup device company and that you're having a lot of those sort of sidebar conversations and how do we do more with less and what? what are the practical ideas to sort of, you know, execute on some of this, or execute on that philosophy anyway. So, no, that's interesting. So we're almost at kind of the end of our time here.

So Lisa, looking back at your successful device career, and I always like to kind of conclude these interviews like this, but looking back, you know, are there one or two things that stand out that you wish you knew back then that you, that you, now have since learned? You know, that list could be pretty long, I think. You know, the one thing I think about, and this is just more for me personally, is, you know, I thought throughout my career, I've often been the youngest person in the room, the only woman in the room, and I think, you know, quite honestly, it was super challenging for me

early on in terms of being sort of the odd man out, and, you know, it was challenging for me to speak up to find my voice, and I think if I look back at it. that. I should have realized I was there for a reason, and it wasn't because I was a woman. It was because I'm capable and the fact that, you know, I could, you know, help solve problems and add value. And so I think if I look back at my career and wishing I would have realized that earlier on is, you know, to find my voice and to speak up and contribute in a really meaningful fashion. So I fortunately have gotten that point to that point at this point in my career. But, you know, It was always the early stage where you wonder, oh, boy, am I really as good as the person

next to me and why am I here? And I know now why I'm here. Got a lot of things to ask. Yeah. That's great stuff. You realized maybe the message is to, you know, for those ambitious folks in the device field, whether you're a young female or a young male, to realize that you belong in some of those rooms.

Yeah, exactly. And it's intimidating. I mean, there's amazing people who've done such incredible things in medical. technology and I benefited incredibly from a number of them and in my team I feel like I stand on the shoulders of them and you know but they're intimidating you know there's an incredibly bright very capable very accomplished folks but the end of the day you're all trying to do the same thing which is you know create value for physicians and patients and improve healthcare and so you know staying focused on that common mission so the rest of things fall on the place

Wow. Good stuff. That's a great, that's a great way to conclude this interview. So for those listening that want to either learn more about you, Lisa, learn more about Intersect E&T, what's the, where would you like to direct them? Yeah, you know, you're welcome to reach out to me. We have a website, first of all, www.propelopens.com. And then feel free to reach out to me directly via, you know, either via the website or just via L, earnheart at intersect e&P.com. Happy to talk more offline. That's very kind of you to leave your email. We'll see. And for those of you listening, if you've gotten some of this out of this interview,

or if you're young and ambitious and want to shoot Lisa in email, you need to email me and let me know how that went because I'm always interested to find out how, you know, what you've learned from, from, as I said earlier, proven and experienced med tech thought leaders like Lisa. So thanks a ton for doing the interview.

Lisa, really appreciate it. And like, I'll just repeat it. You said the website was Propel-O-O-P-E-N-S, P-R-O-P-E-N-S. Yeah. Propelopens.com. So check it out if you want to learn a little bit more about Propel and Intersect E-N-T. So very cool. Lisa, I'll have you hold on the line real quick. But thanks a ton for listening, folks. And again, if you're listening to this online, feel free to check or download the, or subscribe, I should say, to the free MedSiter podcast. Just do an iTunes search for med site or M-E-D-S-I-D-E-R. The podcast will come up, click the subscribe for free,

that way all the new interviews will automatically download to your iTunes account and so you can consume these interviews in a number of different ways. So thanks for everyone for listening and until the next episode, take care.