Signature Series: 1 on 1 with David R. Amerson, Former President and CEO of Neotract | LSI USA '25

Josh Makower  0:04  
Steve, thank you very much. I really appreciate it, and thanks for being here on a you know afternoon, this is going to be particularly fun for me, because I'm getting to sort of share the life journey of someone who I truly respect and have learned so much from. And we've obviously had a great partnership over many years, and that continues in a number of different ways. But what I what I love about this, and of course, with my, you know, sort of professor hat on, is really just to get into the making of a leader like Dave, and if we can all, like, sort of learn from his experience, it all. It helps, it lifts everybody's boat. So anyway, Dave, thank you so much for being willing to do this pleasure. Appreciate it. Let's start with the beginning. You know, where did you grow up? Yeah, tell me about like, you know, the things that formed you into your, your early, early directions as a as a student, into a person in business.

David R. Amerson  1:11  
Yeah. Well, interesting. I grew up in, or was born in, a town called Augusta, Georgia. There's going to be a little golf tournament there in a few weeks. Josh doesn't play golf, so he doesn't really care. But grew up as a Navy kid. My father was a corpsman in the Navy, a chief petty officer. So we traveled really all over the country. Place I really remember first was Hawaii, and we were talking about Hawaii last night, I went to elementary school there and sort of lessons learned they had last day of school, or second to last day of school. They had what was called Kill Holly day. So it was all the white people in the school. You had to run home as fast as you could. So the good news is I learned how to run really fast, and then lived in San Diego, Charleston, South Carolina, North Carolina. I think growing up like that for me, Josh, was you learned how to be a chameleon, to learn the to meet people quickly. I'm actually sort of an introvert, but you learn how to, you know, learn people really quickly.

Josh Makower  2:12  
Wow, I never would have thought you as an introvert. Yeah,

David R. Amerson  2:15  
so went to, I was a first generation college student. When I took the S A T, there was no like my son who had a Princeton Review and had all this stuff. I had a number two pencil behind my ear, and took the S A T and went to the University of West Georgia. My first job out of college was with a consumer products company called Newell. And I looked at the math. I made $22,500 my first year out of college today, that's worth about $70,000 got a company car, and I thought, wow, I had made it. So that was sort of my start into the business

Josh Makower  2:53  
world. That's awesome. And how did you get sort of into the medical device

David R. Amerson  2:58  
field? You know, it's all about the networking. One of my good friends, dear friend, his name is Robert white. He was helped start a little company. Was a urology company called Osborne medical systems. I don't know if anybody's heard of that, but I was they. He had reached out to me. They were looking for a second sales person that covered the East Coast of the United States. It was a product to treat erectile dysfunction, and so I took the job. I was the second salesperson. I want to say there was probably 10 people in the entire organization. So we were building the plane as we were flying it as a young guy, I was building hiring people that were older than I was, love former military people, building sales training, developing what we called zone plans, but really having to roll up my sleeves and learn things really quickly. So you know, my father, as I mentioned, was a corpsman. So I always loved the medical side in our house, if I got stitches or somebody got hurt, we were doing that stuff at home. So I was always attracted to the medical side. So I would go to all these trade shows, and I would run across people that this was a noninvasive solution. Medicare reimbursed. Had FDA clearance when I left there in 1990 which long time ago, the little company on an average selling price of $200 was doing over $25 million amazing. Put that in perspective, if you're doing 1000 that was 150,000 devices a year. So I got recruited back in 1990 by Chris Conway. He was the CEO of a company called mentor. A mentor at the time, had a urology franchise and a esthetic franchise, and I knew I wanted to get into the surgical side, the device side of the business. Yeah. Now, did you have

Josh Makower  4:51  
any mentors through all these transitions that so far, or is this sort of self, self guided space? No,

David R. Amerson  4:59  
I would say a little. Bit of both. One of the when I went to work for mentor, there was a guy there by the name of Don Brown that was just a great mentor. He said, Dave, you've got, you know, a good pedigree, hard work, good ethic. He goes, I'd love to support you to get your MBA. So, you know, during my time at mentor, and this was before I would say, MBAs were in fashion. I ended up getting going to school at nights and getting my MBA. The other person I thought was was great was a guy by name of Kris Kennedy. Used to work at Johnson and Johnson, and throughout my career, as I've moved up, you know, the the ranks, I still believe, by heart of hearts, one of the most important positions in a in a commercial organization as a regional sales manager, right? There's such an important piece, small span of control really, making sure a playbook is being followed. And Kris was really instrumental in helping me become a better manager.

Josh Makower  5:53  
Yeah, and mentor was on a real role. I mean, mentor was a high growth company, obviously, ultimately, it was purchased by Jay and Jay but, but that was the real early day for mentor and high growth period, right? Yeah. So talk about, like, what roles that you played there. I think ultimately you were in charge of whole urology business, right, correct. How did you, how did you get there, yeah. So

David R. Amerson  6:20  
when I took over, when I started at mentor in again, 1990 I took over as a sales rep in a little bit of territory in Tampa, Florida, we did both esthetics, plastic surgery and Urology. So sales, the sales rep, you did both. You put your hat, a urology hat on, and then your plastic surgery hat on. That territory was doing less than $200,000 per year. 12 months later, it was doing about $1.4 million a year. So they quickly moved me up to a regional manager, thanks to Don and Kris. But they also decided to split the division, as they realized, Hey, this is just too much for any person to handle. So they split the company up into an esthetic division and a urology division. And I chose Urology. I just really love that specialty, and I just like the the the personal aspect of that business

Josh Makower  7:13  
in At what point did the next opportunity come calling and you thought it was like the right time to leave, yeah,

David R. Amerson  7:23  
so I got a chance to take over as director of sales. And that was before, you know, with, say, COVID, where you had the opportunity to, you know, be the director of sales, deliver anywhere you want. Back then it was, if you wanted to be the Director of Sales, you needed to move. And guess what? I grew up moving. So moving, I moved from Tampa, Florida to the tough town of Santa, Barbara, California, and man and took over as director of sales there, and then progressed there to be becoming the general manager of the urology business.

Josh Makower  7:57  
That's awesome and and how I mean, the next transition was to call plus, right, correct. And what talk about, like, how that transition, what, where had you, you know, gone to and mentor, and how did you make the decision to move over there?

David R. Amerson  8:15  
Yeah, so it was we. So as I mentioned, mentor had two divisions. We were going to actually spin off the urology franchise and and make both companies public, similar to what Teleflex just announced that they're doing with their business. We were going to have a urology franchise and a plastic surgery franchise. I was going to believe that urology franchise, we ran a dual process, and ended up selling the business in 2006 to Coloplast. Is a big multinational company based out of Denmark. So at the time I was the general manager of the mentor business, I actually led that transaction to colaplast. We sold the business for half a billion dollars, and they made the decision. Colaplast was obviously based out of Copenhagen. They had a footprint in Atlanta, Georgia. We had a footprint in Santa Barbara. They brought in Boston Consulting and said, Hey, let's just move the company to Minneapolis, Minnesota. So, you know, the hard part of that, candidly, was a lot of people from Atlanta didn't want to move to Minneapolis. And obviously nobody wanted to move to Minneapolis from Santa Barbara, so I wasn't moving either. So I negotiated with colaplasty that they wanted to keep me I'd need to commute back and forth. So I did that from 2006 to 2011 

Josh Makower  9:34  
Yeah, that's incredible. And you know, the the way I found you is Josh Levine, right? You know who was CEO of mentor, right? And I met him after the acquisition by Jay, and Jay and I was on the search for a leader for Neo tract. And literally, Josh says, I know the guy. This is the guy at Dave. Emerson. I was like, make an intro and and he was right. And, you know, the funny thing about this story is I had to interview many people, but Dave was the only guy that showed up. First of all, exceptionally punctual. Punctual for the entire time I've known Dave right on time, which is important to me as well. So that was like a instant bonding experience. But he shows up with a presentation about why he's the best choice and what he's going to do for the business. And it's the first time that anyone had ever done that for me in an interview, and he had already, and it seemed already had a deep assessment of the company, where we were, what we needed to do, and how we were going to win. And I think I just sort of was like, I'm sold. I mean, Freddie, but it was an impressive thing. And I wonder, you know, where'd you? Where's that come from? Because I'm sure many of us in the audience have interviewed people for positions, and I've really never seen anybody do that so effectively. So where did that come from?

David R. Amerson  11:05  
When you grow up as a military kid, you're always on time, you're never late, you shine your shoes, you you make sure you're prepared. I think it's just something that is was engraved by my father to make sure we did that. And you know, the interesting part, we talked a little bit about the Osborne medical systems. We took a lot of the as I mentioned, we hired a lot of former military people, and they were just great. They were trainable, and they had a strong level of discipline. And I think it's just such important to have some of those. I call them skills that you don't aren't that hard to have, that I can, I think can make a lot of people successful.

Josh Makower  11:43  
So now you're, you the CEO of Neo tract. We, you know, we're still sort of working our way out of some challenges, and can talk about that transition, because this is something that a minute. I know there's a lot of CEOs here who've come out of bigger companies, but talk about the experience of coming into a small company and sort of, what's the, what are the new challenges? And, you know, how are you getting your bearing?

David R. Amerson  12:11  
Well, it was, I mean, Roger Brooks is the one who reached out to me and said, Hey, I've got the New York Yankees of boards. Who was, you know, certainly you John Nara, Bob Croci, I mean, it was just a great board I had done, certainly the research on the BPH space. And there been a lot of, you know, over promises and under delivering in that space. But after I had a chance to really understand how the eurolift technology worked, I really felt like this could be a real winner. We had a great technology, we had a great board, but now it's about, how do we put the ingredients together to make the company successful? I'll tell you my first board meeting, and Josh probably remembers this, but we just to set the tone back in 2011 June, when I came on board, we were trying to sell product in in Europe, we're having a challenge enrolling our pivotal study, and we had a some mechanical challenge our r, d and operations, people just didn't get along. So that's what I I walked into when we were burning a lot of cash, but I just knew the ingredients that were there for success. So my first board meeting, which was pretty brave on my part, I said to the board, I said, we're not going to this for the next 12 months. We're not going to talk about revenue, but company hasn't earned the right to deliver revenue. So we took a good look at the cash burn. We eliminated a few positions. We really deselected a lot of European countries, and we focused in on our clinical trial. I came in in June of 2011 we had enrolled 40 patients. 40 goal was 206 patients. We met with the team, we got alignment, made sure we had the right physicians in place by the end of 2011 what five, six months later, we had enrolled another 146 patients. We were able to enroll the entire clinical trial in 2011 Yeah. And, you know, for me, it was, and we'll talk a little bit about culture. What was, you know, developing that culture of accountability and performance. You know, we're going to be a performance driven organization. We're gonna set realistic targets that we're gonna truck the heck out of those targets all the time. So, you know, I'd say, you know, first was developing that culture, setting the vision that we were gonna be the leader in BPH care. And for us to do that, we needed to, you know, get the study enroll. 

Josh Makower  14:38  
Yeah, one thing that I learned from you and watched you execute, and of course, I've had some chance to work with great folks, Bill facto beforehand, but the thing that I saw you do exceptionally well, which I have absolutely copied and stolen from you, which I really loved, was you built a vision and then tied it to. A small number of very specific objectives which ladder to that vision that are accomplishable in, you know, whatever set time frame of the year, and every single meeting, it was the first slide and every and of course, there were sub components for every person in the organization and what they owned of those pieces, but the consistency and the repetition and it, it got to the point you could walk across the company, and as we grow, you know, 200 200 you could shake anybody and say, what are our five things? And they could repeat it. And I really appreciate that. And I saw you execute on that throughout the time that we work together so incredibly well, you know, talk about, you know, that that I don't know strategy or mindset, you know, how do you, how did you develop it? And then, how do you think about it when you go into or an organization, how do you create it?

David R. Amerson  15:56  
Yeah, let's teamwork, you know, Neo track, and I think the other companies I work with, it's we, not me. And I think you have to get people to believe in the vision and establish a culture, a culture of it's performance driven, but the North Star is really the patient at the end of the day, everything we're doing is around the patient. Yeah, and I have a pretty simple philosophy, if a patient's happy, the surgeon's happy we win as an organization. And so really establishing that we spent a lot of time on engagement. How engaged were our employees? I feel like if you've got a level of employees that have a high level of engagement, they're going to do the extra work, you know, they're going to work a little bit harder, spend more time, because they know what that engagement looks like. And so we would track employment engagement through Glen or Gallup. We did those surveys twice a year. We took those things really seriously, and we would find as a leadership team, we would find two or three things that we felt like could move the needle on our culture. And I'm proud to say that we had a employment engagement score in the 95th percentile. Our regrettable turnover was less than 2% and, you know, people really understood our vision. I interviewed, you know, typically I would interview, you know, probably the first 150 people that came in the organization, people, you say, Man, this is a hard company to come to work for. And I would say, Yeah, because we want to make sure we find the right people. You

Josh Makower  17:25  
know, you did something else that I think I really appreciated, and saw you do so well, and I don't see many people doing it at the time, when we were ready to go to market, we're talking like, okay, let's hire VP of sales. And said, No. Dave was like, No, I am leading the sales organization myself. And there were some like board members that were like, We you can't, you know. And you were like, no, no, I want my fingers in it. I want to know these customers. I want to be in the field. And you know what? I really think that set the culture of execution at that company right from the beginning, your commitment and direct engagement with customers, not having someone in between you and the direct sales force, but you being in out there, I actually think that was transformational, because we had to build, I mean, there's, there was a lot of new ways of thinking to be able to adopt this technology. This was not a no brainer, and I just appreciated that so much. Amazing. Yeah, well,

David R. Amerson  18:26  
listen, I it was interesting. Back in 2024 I was looking a board had reached out to me about potentially coming on board. So I wanted to, I like the technology. It was a little questionable on the leadership team and the board, but I reached out to they were struggling with sales, and I reached out to the Chief Commercial Officer on the phone. And, you know, ask him a lot of questions. And one of my question was, how much time you spend in the in the field versus the office? He's playing 90% of the field, assuming 90% of the time in the office, 10% in the field. And I said, the wrong answer. I said, you know, as a company that's trying to grow. This is a customer facing in your face business. And you know, I do think that with an early stage company, John NARAS, voice keeps ringing in my ear. Dave, how long does it take for a rep to come productive? How long does it take for a rep to get to a million dollar run rate? How many customers do we need? And I always felt like you can't develop a strategy or understand the business sitting at a desk. You need to be out there speaking to the reps and speaking to the customers. 

Josh Makower  19:28  
So we're gonna, you know, 30 minutes gonna be I fast, so we're gonna go right to the moment of the choice of acquisition or IPO. We've got our s1 file, great bankers, lots of enthusiasm out of the company, and seriously, at the last minute, literally, maybe a month and a half before we're supposed to go live with the offering up, shows up Teleflex. 

David R. Amerson  19:52  
Yeah, and we have another one as well.

Josh Makower  19:55  
So we had that trip. Yeah, that's true. But you know that we were not. Really liking the other one as much. But anyway, talk about that decision. Because I think, you know, looking back what you built, you know, to 350 million sales or thereabouts, obviously would have been valued at multiple billions, right? And we sold it for 1.1 talk about, like, how you, you know, the decision at the time, and then as you look back at it, was that the right tree,

David R. Amerson  20:29  
yeah, well, you know, to back up just a little bit further on that, I do want to test based for two seconds on the reimbursement side, because I think that's the area, the other area I think really added a lot of value. And that trajectory. I was looking back. You know, we went from 4.5 million in year one to 18 to 50 to 100 to 200 it kept going. But reimbursement, we didn't have a category one code. We had to work on getting that. And I, you know, one of my recommendations to any of the CEOs out there is own reimbursement as well. I think it's a lot of people look at it as a cost center. I personally looked at it as a revenue strain and really owning that society relationship and really mapping out that strategy. But you know, the piece of the transaction, you know, getting the s1 we had chosen NASDAQ to represent us. We had our book with JP Morgan, Morgan Stanley, William Blair and and I think it was, yeah, Larry, thank you. Lined up and ready to go. And we had done a non deal road show. We had done a couple of mock earnings calls. We were ready. And, you know, we sat around the board and blindly, almost, is interesting. We all wrote on pieces of paper what would it take to take us off our pathway, because we absolutely would have been the shining star of the IPO market, and we all knew it needed to be with a B to go out. And, you know, I look back now, and I personally have zero regrets. You know, the business is hard COVID, we would have definitely diversified our portfolio. I'm not a big fan of being a one product company. I think you you need to earn adding more. We have added more. But, you know, I look at COVID, the impact COVID had on elective procedures, I've certainly seen how what I think is still a great technology. The integration with Teleflex the first three years, I thought was great, but when we started losing that we but Teleflex started losing key people, it moved down. But I still think we would have been a very, very successful public company, but it was nice for our investors, for the board, for management team, to take the risk off the table, yeah.

Josh Makower  22:43  
So we have very limited time so much more to talk about, but I'm going to talk about the pivot that you've made since then to sort of being a, you know, board member, right? And and really been multiple boards, and I would say, very successfully. I think the count, you know, including the attracts like over 3 billion, and the orders that you so, you know, Midas touch here, which we're hoping you bring to Moximed, and the other businesses that you're on, but as well that are still going but talk about that transition and how it's different than being a CEO, and What are the principles now in that board member role that you sort of follow in that

David R. Amerson  23:24  
kind of capacity. And I tell you, I love being a board member, and one of the things that you know I'm always trying to be, first of all, I really take the boards seriously. Being on some other boards, people show up and they haven't read the board deck. They're not asking the right questions. And I want to, I want to be add value when I show up at a board meeting, but I'm not the CEO, and I think that's the one thing you learn, is you're there to provide guidance, to have honest conversations. The one thing that I've tried to be to the CEOs is that therapist as well, get those calls and they say, Dave, would you mind taking your board hat off for a moment? And yeah, take the board hat off. Okay, how would you handle this issue with the board? And I enjoy that to really be able to provide some guidance to, you know, the CEOs have said, Hey, you may want to think about it this way versus this way. And you know, always being available, but, you know, not running the company, but willing to ask tough questions, to challenge them to make the right decision,

Josh Makower  24:24  
awesome. So two more topics, yes, one is failure and overcoming adversity. Share a story or sure you how you approach it. Obviously you know you can't be as successful as you've been without actually experiencing failure, right? So talk about one of those, one of those moments, or, you know, tell us how you where you go to to get through that and

David R. Amerson  24:52  
solve things. Yeah, you know, two things come to mind, I think the early days of, well, any career, it's when you have to. Assess an organization. I think Neo track, again was a good example. And, you know, candidly, going from mentor to colaplas, where we had to hire, it was, we were basically hiring a brand new organization, and it's really identifying the right talent, you know. And you know it Neo track, it was making some tough decisions early. I mean, we have some people that were legacy people there, and they just weren't the right profile for what we were looking for. And I think, as a leader, especially in a smaller company, you need to make those decisions quickly and make sure you're bringing people on that can add value. You know. The other thing is, you know, the international market. I think there's been a lot of companies who go out there the international market first, before they enter the US market, thinking that it's just going to be easy. It's not, it's hard, it's expensive, and we certainly experienced that at neotrac, that we needed to earn our way into the international market by proving ourselves in the US market, and then really selectively pick markets like Australia, markets like Japan, where we thought we could really build some opportunity and not hurt the brand. I see too many companies go to outside the United States, and they get bad outcomes. And else who is going to impact their outcomes in the US

Josh Makower  26:13  
absolutely focus. So some words of advice for you know, this group here. I mean, many of, many of the group, are in search of that first big exit, you know, and maybe facing either a big financing or, you know, putting it on the market and and making it happen, you know, what? What advice can you give? Yeah,

David R. Amerson  26:36  
you know, every I get back to the it's like a broken record that North Star, the patient, you know, to me, that's the most important thing is, we developed a program years ago called consultative skills development, and it was one of the things we found was, you know, physicians weren't great at speaking to patients, so how do we make sure that we find, First of all, we train the physician the right way so they get great patient outcomes that we focus we we focus on going deep versus wide, and then we focus on great patient outcomes. I've seen too many great technologies, and I can name a few that get got get so focused on. Let me train a physician. You do one or two cases. Let me move over to that next physician. But they never growing that physician base they have, and I'm a big fan of you know, be focused on driving utilization within a practice, because I'll tell you, that's what the strategics are going to look for, is how sticky your customers are. And I believe that the sticky customers, the ones who are trained, well, they do the procedure right. They're the ones that are getting the best outcomes right. And so I would say, continue to focus on the North Star. And then, you know, make reimbursement of core competence within your organization. Yeah. And then finally, culture. Culture eats strategy for lunch every single day, and be involved in the hiring of every person. I mean, you think about that product, the person who's actually delivering, you know, the shipment to UPS, they wonder, do they have an impact on the business? They absolutely do. They're making a difference in that patient's life by delivering that product. You know, you as a leader, you spend a little bit of time with that individual, somebody in manufacturing, it makes a huge difference to the culture of the the organization and everybody making sure they feel like they're involved.

Josh Makower  28:36  
That's fantastic. Dave, Thanks for, thanks for sharing those things with us. And also congratulations on all your success, and we can all learn from you, as I continue to do. I also want to just thank LSI, this is I am thrilled with the energy, enthusiasm the group here. Really well done, guys, that's outstanding organization. Well run meeting great content, and you know, you got all the right people here and and they're all benefiting from so thanks for what you're doing for the ecosystem. We really, really appreciate it. And thank you, Dave, for a great, great chat. 

David R. Amerson  29:12  
Thanks Josh.

Josh Makower  29:12  
Thank you so much. Thank you.