Upending the Medtech Sales Model

Scott Carson  0:06  
We like to buy things. We don't like to be sold things. But healthcare is an industry and healthcare devices pharma, med surg, where devices and med surg environment is sold. And when we started our marketplace empowered by MRP, we started out as I mentioned earlier today, we started out in aesthetics versus ultrasounds, IV pumps or imaging, or DME, and we started aesthetics because it was we needed a place where we could learn how to how customers, how administrators and practitioners we want to purchase. And we learned some things early on about aesthetics. It's a marketplace or a market that grows roughly 10 to 15%, year over year. It's highly emotional in the buying process. And it's cash based. And these are things that do well in a marketplace environment. Some of the other healthcare sectors will have to adapt differently to things such as payment. But aesthetics provided a great place a great petri dish for us to experiment over the last seven years. And we've heard a story hundreds of times about clinicians and administrators being sold goods. And there's a doctor that from California, since we're in California, I'll reference her her name is Dr. Kay. And Dr. Kay is an OB GYN. And an aesthetic rep came in and said, you know, you're under serving your patient population, because you're not offering feminine rejuvenation, hair removal, body contouring, and you should be considering these things. And he sold her a piece of equipment, let's say it was 75- $100,000. Over several months, that device didn't really perform from a financial standpoint, or give her the success she was looking for, for her patients. So the sales rep said that you need another one. And he sold her another product. And that went on to the total of $800,000. In sales where she now has to go back to work longer. She is spending less time with her family. And so the thing that she wanted the most, which was freedom and movement away from a third party reimbursement model, she got sucked right back into it. because as we know salespeople always have the best product, they never have the second best product and they are aggressively selling because manufacturers for the most part, are stakeholder and shareholder centric. And so what I would challenge is what if just what if there was a market where products and services and pharma could be displayed in a transparent manner where there's good better best flat rate pricing, peer to peer reviews that are not monitored or administered, administered, where people can really clinicians administrators can see these products and how they perform, you could look at uptime, serviceability, a form of Carfax where you could look at the history of the product, whether it's new or pre owned. And we believe very much that this revolution is going to happen in healthcare across the board. And the reason for this is because of something pivotal that happened in the last few years. And that's the people making decisions and the clinical practice or the administrative practice, are now digitally native. They're in their mid 30s. And they grew up with technology. And if you look at many of us myself, well beyond 35. And many of us that are in this room, we are not digitally native. And why that matters is is digitally native, they expect this kind of experience. We expect to go on to Airbnb, or to kayak or one of these platforms. And it doesn't matter if it's real estate, consumer goods, Home Goods, doesn't matter what it is we want to look at the reviews of our peers, we want to look at kind of flat rate pricing. And we think that this is coming and we're seeing evidence this is moving quickly. And one of the things when I was putting a panel together I wanted to bring to this community, this healthcare med tech community, some thought that might be unique to what many of the investors and CEOs are thinking about. And one of them is a friend of mine named Ashwin, with us and he was running business development at Airbnb just until recently and spent the last eight years there and I thought it might be helpful Ashwin if you shared some of your experience over the last eight years at Airbnb and what you saw, because I don't think that really this industry is understanding what took place there. And by the way, this is called Airbnb has what's called a side by side managed disruptive marketplace. This is defined by a gentleman named Clay Christensen at Harvard, who passed away last year, but really was pivotal in defining the difference between a managed marketplace side by side marketplace and the disruptive, side by side marketplace such as Airbnb Ashwin, can you share some of your experience?

Ashwin Krishnan  5:23  
Yeah, where do I start? Well, you know, I joined Airbnb, during what many would call the early days when Airbnb wasn't fully mainstream. But it was growing rapidly. And one of the reasons I joined was because I was really bullish on the impact that the internet was going to have on not only the travel industry, but all the industries that we operate in, including med tech, which is much of the reason why we're here today. And my big takeaway from the eight years there was that I vastly underestimated the impact that the internet is going to have. And it's going to continue to have on all of the industries, the way we work, the way consumers make decisions, and the way economic value is created. And ultimately, you know, Airbnb, today has grown rapidly. I mean, we're talking about 6 million homes across 220 regions and countries with over 1 billion guest check ins since you know, its founding. And why has AirBnb grown so quickly? I was talking to someone in the lobby earlier this morning. And she said, Well, you guys invented a category. That's actually a common misconception. And it's not true. Vacation Rentals. Short term rentals existed long before Airbnb ever came to be decades before in fact. And you know, what's really happening here is we need to take a step back and understand the forces at play, and what the internet has given rise to and we've all heard this before that the internet is changing the way we do business, but unpacking that actually leads to some interesting insights. And the internet has given rise to a new form of aggregator, and I'm borrowing a lot of this from Benjamin Thompson, who's one of the great thinkers in tech, he runs a great paid newsletter at stretchery.com, I highly recommend you subscribe, because if you're interested in anything, technology is a great way of distilling this. But you know, prior to Airbnb, the number one factor in determining where you're going to stay at an accommodation was trust. Trust mattered more than anything else, and hotels had it and homes a random home in a random city did not. And that's why short term rentals vacation rentals were a very niche niche asset class. And what Airbnb did over over the years is they they dedicated the vast majority of their resources, not to selling travelers on traveling on Airbnb, not to marketing at potential hosts and getting them to list their homes, but on product centric development, and building a platform that digitizes trust. Now, what does that mean? How do you digitize trust, number of ways that manifests itself but number one maniacal focus on design, two out of the three founders were designers at heart trained designers and focusing on creating a world class customer experience that gains the trust of consumers. Number two, leveraging cutting edge technologies like AI and machine learning to improve the safety on the platform and detecting fraud and all the things you would expect in order to feel safe and be able to transact on a platform and trust that platform. And number three, you know, things like ratings and reviews that we're all used to in an E commerce context. Now, coming out of building a platform like this, the condo that I list in New York City, that's my own condo can have just as many reviews on a platform like Airbnb as the local boutique hotel has on TripAdvisor. And so now what we're doing is we're essentially democratizing trust, and trust becomes a commodity. And so by commoditizing, trust, by commoditizing distribution, what the internet has done is it's changed the factors on which we compete. And so now, we don't choose an accommodation purely based on trust. That's one of the factors. But since Trust has effectively gone away, because we can digitize it, we can look at factors like location and price and convenience and experience and the user experience to help differentiate and that's kind of by by continually investing in the user experience that brings more suppliers hosts onto the platform, which brings more users onto the platform. And that's been the virtuous cycle that's helped Airbnb to grow into what it is today. So what does this all have to do with med tech as an outsider coming into this industry? I work with private medical practices. And I have a couple takeaways. Number one is that from an organizational perspective, focusing on one too many activities one too many initiatives that widen your funnel are more ROI positive in most cases than one to one sales interactions.

Number two, your customers, your prospective customers, your buyers are all better connected with one another than they ever have been there already, they already know about your product. They already know what other people are paying for your product they've already made, they've already reached towards the bottom of the funnel before you even engage with them. And so understanding that and getting further up the funnel and engaging through content is really important. And number three, because distribution and trust have been commoditized. There's no better time to be an entrepreneur in this industry. And I saw so many wonderful pitches yesterday and continue to watch them today. And I'm inspired by a lot of what you guys are building. So I'll stop there.

Scott Carson  10:41  
Just one follow up question is, when you look at these presentations, assume you looked at their websites. What did you see when you looked at the presentations or the websites? That is different from what you experienced? In a side by side disruptive, managed marketplace? Or what we experienced today in everything that we we purchase? Well? Yeah, I mean, I think, you know, number one is generally a lack of transparency. I think that you know, in, in med tech, in particular, you're dealing with really complex topics that the typical user might not be able to understand. But there's still generally a lack of transparency. When I go to a lot of these websites, I can't I don't know what the price is, I don't even know what the order of magnitude of how much this product costs. I don't have side by side comparisons with the competition. I don't have case studies. It's oftentimes just leading me into a form to fill out to engage with somebody. And you know, one thing that's happened on the enterprise space, especially in enterprise SAS, you're seeing enterprise SAS software companies invest heavily in self service models in content in their hiring their own editors. They're creating self service models where people can go in and transact at very high volume. Right off the bat. And I think that's one thing that I've found, it's missing in this industry. I'm gonna circle back to a question with you. But I'm gonna go to Omar for just a minute. Because Omar earlier we were talking about some of the early signs that there's change coming, and you were referencing Pfizer, and some other companies, you want to speak to that?

Omar Khateeb  12:11  
Yeah, absolutely. So, you know, I think everybody in this room is pretty well aware that Pfizer has made a lot of money in the last couple of years. You know, last year, their revenue was around 80 billion to put that in comparison in 2020. But you know, right when the pandemic was going, they're estimating like 23 billion, then they upped that to 32 billion. So of all the companies on planet Earth, they could afford to keep people. Just a couple months ago, Pfizer had a mass layoff. And when I say mass, it's in above 500, probably in the thousands of salespeople, who just laid them off. And the article stated that the reason why they did that is because when they looked at their data and research, they showed that their customers were preferring more digital meetings. So not only did Pfizer just lay people off, they decided just to do that, they didn't even say, hey, let's just keep these people and train them, just laid them off. And when I when I brought this up in certain talks and articles a few few months ago, I got a lot of angry emails, of course, as normally happens with me from like, VPs of sales, usually medical reps, which is like, oh, you know, this is ridiculous, just Pharma. That's not going to happen to us. Amgen did the same thing. They laid off 500 People for the same reasons. And, you know, I think it's purely based on delusion and cognitive dissonance and arrogance that our industry thinks that this is not going to happen to us, because for some reason, our industry thinks that the sales reps relationship 100%, just purely in the fact that they're buddies with the doctor, and they've been doing this for a while, that that's enough just to sustain business. But to Aspen's point, these physicians, they don't put on their white coats and go to the hospital to become a you know, magically a different person, they the same kind of person that you and I are at home, which are consumers are being conditioned by enterprise SAS, by consumer by Airbnb and eBay. And sooner or later, as of now, they're going to start doing that with our industry. And actually, they already are, even those modalities don't exist. If you look on LinkedIn, more and more orthopedic surgeons are doing what acting like consumers are literally taking photos of themselves with the implants, posting on LinkedIn, you'll see anywhere from 10 to 30, to 50 comments of surgeons having discussions, there's not a single rep to be seen anywhere. So it's already happening.

Scott Carson  14:13  
I make a statement that I'm sure we'll get some pushback in this room. But I believe in five years or less, there won't be any more Field Sales Reps as we know them. And so what's going to what's going to make up the difference? Or how will how will we get products to market but what are your thoughts on that? Do you think that's a possibility? Omar?

Omar Khateeb  14:36  
This is one. So this is one area I'm going to disagree with. So you're you're saying that in five years, that sales reps are gonna go away, they're gonna be disappeared,

Scott Carson  14:42  
I think they'll become irrelevant. And there won't be a purpose. And if you think about the 25% plus and minus that after r&d is done, FDA is done product manufacture is done development is done. The single largest component of the product cost is sales and marketing. And if you can deliver transparent information, the sales rep serves virtually no benefit. And so what would be the purpose if you can't take that 25 plus percent, and give it back to the community of healthcare, give it back in lower pricing, creating greater access, increasing quality? There's so many things that that can impact but you feel differently.

Omar Khateeb  15:20  
Yeah, and it's for a couple reasons. But there's, I think we do have some common ground. But let me tell you, where I disagree, where I disagree is this is that for, I would say, for everyone, there's a lot of good sales reps out there who serve as trusted advisors to the physician because they see thousands more of a specific case with a technology that the physician will ever see. And physicians do surgeons, you know, let's I'll be specific, do rely on salespeople for that kind of guys. However, one, every one good medical sales rep, who's that kind of person, I would say there's about 50, worthless ones, they literally process orders, they show up to the hospital, they get in the way, they provide no value to the OR and personally, I don't know what the hell they're doing in there, right? Now, the reason why I think that it's not going to happen, although what I think is going to happen is that you're gonna see a reduction in Salesforce because you don't technically need, especially, you know, given the situation with what the doctor wants, and what the hospital wants, which is no sales reps, you don't need 20 sales reps to go to market anymore, you probably need just five. The other reason why is that, and again, I'm gonna get you know, I can't help but say it this way. This industry has been extremely arrogant and lazy about these things, these things that this is nothing, none of this is new. This has been going on since I took 2013. And McKinsey, and this is, you know, I have to compliment you and your team. He did fantastic work and providing some researchers, you guys shared a statistic with me that I thought was interesting. McKinsey does study, and four or five years ago, they asked all these med device companies, about 100 of them, what percentage of your you know, of your budget is being spent on digital marketing. So five years ago, I'm not really good at math. But let's what like 2016-2017 not that long ago, it was 20%. Like, like, actually less than 20% was on digital marketing. What was it in 2021? 50%. So my question is, where the hell is this other 50% going is probably going to just absolutely worthless things like bus wraps and conferences, everything, which by the way, I love conferences, but spending $10,000 on a bus wrap yet saying, Oh, how are we going to get an ROI from this digital campaign, it's just insane to me, insane. And on top of it, let's say we get rid of the sales reps, just all of them fought in five years, they're all gone. That would mean you have to have really damn good marketing, which to Ashwin's point, that means there has to be a full end to end, transparent journey so that the customer, when a doctor wants to talk to a salesperson, they'll talk to them. In the meantime, they have to provide that information. There's one one last thing I want to add is, we would all agree that Johnson Johnson has got a really impressive brand, they got a lot of money. You know what happened in today, I was talking to somebody and they didn't believe how bad it was in this industry, because persons from SAS. I was like, let's go, let's just assume you know that of all the platforms like LinkedIn, they they advertise on there. And he's like, yeah, like, let's go look at that. So which by the way, you can do that on your desktop. So we go to Johnson Johnson, we go to the pew, spine division, they make a lot of money. We go to their ads, I find it out this. I think it was a it was an implant for the hip or something. It was like their hallmark device, right? 30 years, this is great thing. I'm like, let's say I'm a surgeon, I say I really want to learn about this. Why don't we click learn more, click learn more, it goes to the worst website landing page I've ever seen. I've seen teenagers put together a better website. But let's, let's just let's just say that they did such a good job. And as a surgeon, I'm like, Hey, I don't care that these are like, extremely low res photos. And they're just like, really not a lot of information here. There's not cases nothing. It's just like, Oh, look at how great this is. It didn't even look good. I clicked contact more. I said, Hey, what do you think's gonna happen when I click this, like, formfields going to come up, you're gonna put your information and sales development reps gonna come up, reach out to you. I'm like, let's help. So I click it, it goes to a landing page with North American global offices. Here's the email, here's a phone number, European officers, you know, here's the email, here's a number. Great experience. Yeah. And that's Johnson Johnson. So you can only imagine what the rest of the industry looks like.

Ashwin Krishnan  19:04  
It's a lost opportunity, I think huge. I think that when when you have a lead and a qualified lead, and you know exactly what they're doing, what they're coming for, there's an opportunity to provide more content and more interactive experience. And you could arguably even get to the holy grail, where you are closing the sale right then in there. Because the price sensitivity for consumers purchasing online is has has reduced significantly since the since the pandemic.

Scott Carson  19:29  
So, you know, one of the arguments may be in the room is that, you know, we're a bunch of innovators. We're but you know, very smart and sophisticated investors and our websites won't operate that way. We're going to really be next gen. And I'm going to ask Sheryl, a question that will follow up on the two things that Omar and Ashwin just said. But the healthcare is continuing to operate in web one. We currently are in web three. we're quickly going to move to web four but But that's the biggest problem is we are incredibly archaic in the way that we're connecting with customers. And now it's not moving in 10 year increments, it's moving in 10 to 12 month increments the speed in which things go so Cheryl one things we were talking about, we put this on the one of the topics is Reddit, you know, why does Reddit matter? And why might it matter to this group of investors and CEOs and sales and marketing leaders? Why does Reddit matter today? And is health care about or currently having kind of a are about to have a reconciliation as the financial markets did last year when it comes to Reddit and platforms like Reddit?

Cheryl Adams  20:39  
Yeah, I think a lot of us kind of dismiss Reddit a little bit. I don't know how many people in the room actually have been on it or, or engaged with it. A lot of us have been on Facebook and Instagram. And some of the other social media platforms, but 52 million users a day are using Reddit. 460 million per month. They're not just engaging in just social communication is liking somebody's picture. Most of the communication is all business, peer to peer communication, reviews, community conversation going on. So it's going to be huge in the medical device. We've seen a lot of physicians on there having conversations back and forth, it's going to make a huge difference in the community and how we're engaging with one another and that peer to peer reviews, and engagement.

Scott Carson  21:34  
These conversations are not just about products. They're about leadership. They're about culture. They're about product, what else do they touch on in these forms?

Cheryl Adams  21:47  
They, really interesting because a lot of them, they talk about controversy. They talk about what's happening, both in government and regulation, and what's up and coming. As far as technology and innovation there. There's people engaging in investing conversations. So it's a wide range of conversations that are going on. And typically when you know, when I've been doing a lot of the research and looking at it, there's 200-300 people joining in these conversations. So it's just not one or two that you're seeing in some of these other social media platforms, there's thousands of people getting involved in communication.

Scott Carson  22:27  
This is the center point of transparency. In this space is what Cheryl just described. And Dr. Koop, we've talked a lot about transparency and democracy in the purchasing process. And again, I want to remind people we purchase in communities, everything that we buy, and you may not think of it this way, but we buy based on safety and fear, often what the community shares with us. And I know this group doesn't think that way. But that's how we operate. So Dale, can you speak to transparency, over the 35-40 years of designing patenting engineering, manufacturing and selling energy based devices and how transparency and democracy is going to change things going forward?

Dale Koop  23:13  
Yeah, well, when you first talked to me about this, it kind of seemed very disruptive, I'm been in the aesthetic sector of the medical device industry have run about a half a dozen companies, and it's probably the least transparent getting back to what Ashwin said about you go on the website, you can't see the price, you can't even see the specifications anymore. It's all marketing story. And it's probably the most sales rep intensive part of the market and the companies themselves are that's all by design. Where they get their value added is in sales and marketing. And to quote a comment I heard from Larry Ellison from of Oracle once, you know, sales and marketing is the only value added. And they and that's how this industry in the aesthetic division works or sector works. A device in in warehouses, the value is its cost of goods, if that once marketing gets a hold of it, they they add value, that's community value. Sales and Marketing is where they get most of the value this it's individualized value. A good sales rep will go into a practice, find out how much they need the product, how much revenue it will generate for them, and try to adjust the price to capture as much of that margin for the company as possible. And that only works if there's not a lot of transparency. So the sales guy can tune the story individually to each practice as he sees fit and the companies are designed that way. If you become transparent, that whole model can go away. The sales rep has less than less value, in fact, almost no value at that point. Marketing still has some value but even less because with the community based transparent marketplace, most of that value now is going to be pushed back into development and in r&d now to come up with good products. Because as you do less and less value added in the sales market, and you have to do better products, and I think that's going to be the benefit for the consumer on this. And I think it's going to go that way, because it's consumer driven.

Scott Carson  25:23  
Yep. The way we purchase is, we're looking for a lot of things in that purchasing process. But it's not to pay more, and it's not to get less warranty or less experience. And health care is, again, I mentioned this earlier is has been, as long as I've been in the industry, and everyone I know has been focused on stakeholder centricity. And we're now moving to a customer centric model, which is the administrator and physicians that the market serves. Coming back to Ashwin and Omar, I want to ask that some probably this group and others that are watching this and may see it down the road will think you know what, I'm going to go get on Reddit, I'm going to go build an E commerce site, and I'm gonna go spend some money on digital marketing. Why is that too late? Why won't that help? Because that's the natural reaction is, is we're gonna go move to more and more digital sales front, Why will that probably not function?

Omar Khateeb  26:26  
I think for a couple reasons. So again, like it depends on on what it is so like, as much as I'd love to see that where you know, hospital can go and purchase a million dollar robot off e comm. That'd be great. Actually. I think I think part of the reasons is that there, there's so many obstacles that have to have to be overcome first, you know, like, before actually even doing digital marketing, you have to come to the to the conclusion that like part of digital marketing is like content, there's a cost, there's an investment in creating content. There, there's some great companies that do you know, in our space to do content well, actually not. There's not a lot of, it's maybe a handful, but content isn't just taking a few photos and just putting this sort of half effort into like a brochure. And that's not that's not content. And there's a reason why like HubSpot billion dollar company, they acquired The Hustle of my friend, Sam Parr's company, which is a blog. Why because there's there's value in content, and something that you know, and I want you to kind of to dive deeper in because I think you understand, or know this better than me, but you can't game the system anymore. So all these med device companies who think they're smart, they're like, oh, we bought out our competitors, SEO and keywords, anything that doesn't work Google's way smarter than you, they are realizing that that's the people game the system. So they're putting more emphasis on authority on quality of content, these kinds of things. So like the three, four blogs, he put out every like what quarter is not enough?

Scott Carson  27:46  
No question. And the key word there that Ashwin maybe you can comment on is conversion, conversion, used to be thought of creating content and converting on a transactional platform. But conversion means much more to Google and search engines today. What do you what would you comment on that?

Ashwin Krishnan  28:04  
Yeah, well, I mean, we're seeing just taking a step back for a second, we're seeing a broader trend where, you know, in the olden days, the newspapers used to control the distribution. And that's where we got all our information. And so they integrated backwards, and they hired the writers, and they managed who writers were, and so on and so forth. But Google has disrupted that on its head. So rather than publishers, aggregating articles and going to the publisher, and then finding articles in the publisher, Google has disaggregated, that whole model. And now, every web page essentially is essentially created equal, right. And so the, the net net of this is that quality matters. And we're finding that leading brands, both on the consumer and the enterprise side, are hiring their own content production studios, they don't need necessarily a PR firm to launch a product, they can use their own channels, and they can create their own content around the product. But it's not enough, as Omar said, to just do this on an episodic quarterly nature, it needs to be core to what you do. So a brand that is building, lasers and the aesthetic, and the aesthetic world needs to create content, not only on the products themselves, but also on what it's like to be an aesthetic practitioner on how to treat patients. While these might be relatively orthogonal to what they're actually selling. But they're crude, that's how they build trust and that's how they build quality. And that's how Google is measuring the authority that they bring to the table. So those hacky, what used to be SEO, like just bolding keywords and putting them in headlines and so on and so forth, are as effective now as quality and Google has found a way to really bubble those to the top.

Scott Carson  29:42  
Great point we think of, howshould I say this? Try to think of a nice way to say this is LSI word let me let me skip past that for a sec,

let me go to regulatory, if I'm sitting in the room and thinking, Okay, this is all perfect, that's gonna be great. But we got real regulatory issues here, that you know what's going to happen in the regulatory space if people are freely transacting goods and services that are class devices on a platform where we have this kind of community that we're talking about? So Cheryl, can you talk about what you see some of the barriers? from a regulatory standpoint, from an ISO standpoint that might someone here might want to consider as we're stepping into this world?

Cheryl Adams  30:29  
Yeah, I think it's definitely a space that we're not used to. Used to doing it through through the sales reps. And through long processes of paperwork, and FDA, I think that what you're going to end up seeing more is a lot of unknowns, alot of complaints, you know, FDA set up MedWatch, several years ago, for complaints, I think you're going to end up having more and more people filing complaints and looking at, you know, what's going on. And potentially, what is the risks of going online, not having, especially in the used devices or marketplace, think that people are going to be more scared, they're going to be more, but it's going to cost more money to actually get them to market. If we don't go that way. A lot of investors are here today. And you know, a lot of startups are looking at how you know, what is the the money going and use of funds going into regulatory is going to be definitely be a big one, that we'll have to watch and see what takes place in the future. FDA is currently right now proposed several proposals that they came out with in late February, that addresses a lot of these issues. You know, we're getting towards the end of the conversation. And does anyone have any questions? We want to make sure that we answer any that anybody has. Yes.

Question 1  31:59  
So we saw the trend of consumer as the space that we're proud of the role of influencers in trying to cut through the noise of specific demographics. Do you see a transition from what's traditionally been the salesperson role into more of the modern sales role for the position, influencer type? Or do you see the content driven strategy be sufficient?

Scott Carson  32:19  
So the question for us is we don't have mics? I'll repeat the question. The question, I think, if I can distill it down as well, we see a trend of influencers or content creators, take the place of salespeople, or sales and marketing, is that summarizing it?

Question 1  32:37  
the person specific rather than the anonymous content?

Scott Carson  32:41  
Yes. So not just influencers or anonymous content could that you know, would that replace salespeople? I'll take a shot at that. And it was actually and then everyone else can weigh in as well

Sales of products we think of and everyone who here knows what that means. So I'm not going to touch on that as it exists today. But it's going to be through information, and gratefulness and kindness and give back is where you're going to create content that converts. What Ashwin was saying about if you can teach people, let's say on how to create a better experience, something they didn't learn in school, they didn't learn to the organization, and you can give that information to them. That's going to create authority on platforms that will generate conversion.

I don't think we're going to see medical device influencers pop up, just out of nowhere, I don't think that's the case, we have that today. And people don't really value that for the most part they're either directly paid or indirectly paid in some way. We all know this. And that's not what consumers that's not what we want, we can sniff that out. As a consumer, if we see that something, I think this is your point, we can see that and we actually move away from that. So if healthcare tries to juice it in some way, the constituents which are consumers, now, digitally native are going to see that, and they're going to run from that. So it has to be and I hate that word authenticity, but it's got to be authentic. And it's got to be centered in trust. You guys want to? Anyone want to weigh on that?

Dale Koop  34:11  
Yeah, I think that's a really good question, I think in in the esthetics, industry, the influencers are the KOLs, or the key opinion leaders, and there's not a lot of difference between them and salesforce, as far as adding value, sometimes real value, sometimes not to up to a product. And I think as you get more transparent, I have been moving towards the concept that the sales reps are going to be irrelevant and the key opinion leaders are going to have they're going to be irrelevant because they beat build awareness. So you're going to be less relevant in the decision making process because of the transparency and the democratization of the process of selling and I can I can actually vision, a time in a few years where there will be no sales reps in our industry.

Scott Carson  35:00  
Any other questions?

Question 2  35:02  
 Yes. Only on the topic, I'm old school, I'm 30 years in this business. So for me the notion of no sale practices entirely, that's a provocative statement. By way of a little bit of history, I saw the first DaVinci robot from Germany. Right? I'm familiar with launching meaningful content and new technology. I don't personally believe it is a viable scenario, in the launch of new products, and the consistent training of new products to eliminate a sales rep. Now in a notion where you monetized a category. Where do you want to pick? When you want to pick 2700 of the same catheter? Yes, I can do that on the marketplace. But when that catheter is different in use for Mary Jones on the table versus Mike Smith on the table, 10 minutes later, I don't believe you can get rid of the sale. Right. So I I've been in way, way, way too many procedures, where I've seen a sales rep provide two seconds of another tiny little piece of something gently to the physician gently, that steered the procedure another way. I've also seen where sales reps are unable to do that, because they're not skilled and experienced enough yet with that procedure. And all of a sudden, everybody gets a little nervous, because they know we're getting ready to go down an alley to do vertigo. Right. So I guess I will challenge against the notion that you can get rid of a sales rep in a procedure oriented operating room cath lab based type of an environment, because the value that gets added there is absolutely tremendous. Having said that, in a world where there is full transparency, and everybody already knows how to use it, and it's fully commoditized. And pricing is transparent. Sure marketplace will work. But I would argue that you can't you can't get rid of the first part. And you also can't get rid of pricing, lack of transparency, because in the world to I've lived in for 30 years, that transparency is not there.

Scott Carson  37:07  
I'm gonna try to summarize that. I'm going to start with we don't agree. I think that's the first thing is we don't agree and the premises is that sales reps, and sales leadership provides tremendous value side by side with clinicians and delivering exceptional clinical outcome that and so based on that this won't work.

First off, I want to congratulate you on intuitive and DaVinci. And what a remarkable story. And we hear a lot of remarkable stories here. But remarkable and I think everyone would like to emulate the success that you've had, and the lives that you guys have touched. And so very remarkable. The second thing is, is you're wrong, and you're wrong, because I want to hear okay, so but you're wrong, because what's happening is we have AI coming. And it's and we're here at this meeting, and we're seeing this a Ford just launched you think about entering the marketplace automotive market. Now, after eBay sold 5 million cars, and it created an industry with auto buy tell that we exist today. Why did Ford enter the space because prior to the pandemic, they sold 8 percent of their cars online today they sell over 30% online in a relatively short period of time, we are seeing the movement to the communication of this information much faster than we ever have. So will reps be minimized? Absolutely. I think we can agree on that will experience and education, find different ways to connect with physicians. But you know, I can sit here and cite 100 industries, where if I was sitting up here and said to real estate, and I would have this argument but they adopted and changed. If I said automotives it would change. So many, how about from Ashwin's world, if you would have said 10 years ago in a meeting like this, remember, healthcare operates 10 to 15 years be slower than pretty much anything else that you are going to see what's called a non producer and a non consumer is somebody that has a couch and somebody that wants a couch come together and find a way to transact and have commerce, people would have laughed at you in the room, it wouldn't have happened. So I don't necessarily completely disagree. I think that there's going to be a place but I think we're gonna see radical changes. And in two or three years, we're going to be in this room. And we're going to see presentations on bolt on technologies to this marketplace that radically reduce the impact of the rep and a clinical environment.

Question 2  39:37  
 I guess I fundamentally disagree. That's good. And for full transparency, I'm the founder of a company called availment systems. We're bringing expertise into the operating room. We're trying to enable reps to do more of what they are so damn good. So full transparency, I don't actually think there's a minimization of what happens what the rep does, and I'm actually gonna argue that emotional intelligence clinically driven artificial intelligence makes the rep better at their job, rather than replacing the rep in their job. So I guess we fundamentally disagree. I'd love to debate.

Scott Carson  40:16  
I'll agree that there's a hybrid coming. How about that? So Can I comment, which is what you're doing? I think you're Yes, Omar, please.

Omar Khateeb  40:23  
Yeah. So regarding you said the the rival, which is hybrid. And I agree with Daniel, and again, I have to pay respects because I referred him as an OG and original gangster, in our industry. So when Daniel has a comment about something like, I take a second to think about how I'm going to comment back on it. I agree that in in certain things where you see commoditization happen, sorry, everybody, but like screws, the screws, like in spine surgery, they're all the same. Marketplaces are going to have an effect on that, I think that's where it's gonna be important. Where it's going to be vital that you have these reps is that when you have new technologies, for example, robotics, or new handheld devices, right?

Surgeons want reps in there. And he's absolutely right. And again, I'm somebody who had gone to medical school, I've, you know, spent a lot of time with surgeons, people get really nervous if the if the there's a new technology in the room, and the person who's responsible for that technology from the company is not there. Right. And in this industry, at least, again, for the people who have been doing this for a while you appreciate this, we always say that we have the things that, you know, the real selling happens after the sale, meaning that that's when the real support happens. And I think that's where the great companies in this industry do. Well, is that how do you train the physicians afterwards? How do you provide the best support, because, you know, changing the status quo as industry to change a clinical workflow from 10 steps to six steps even is really, really difficult. I see. That's where you see the value of reps. The last thing I'll comment on is even mentioned hybrid. What I've been trying to collect as much data as I can over the last, you know, seven, eight years on is that the rep is going to evolve, I think they will disappear. But they're going to be evolving into what somebody who's 60-70% sales, the other 30-40% is really marketing, which is how do they engage? So those orthopedic surgeons, and there's more of them spending time on LinkedIn and Twitter posting and engaging clinically, how do you enable that person to go have clinically relevant conversations with that physician? And then how do you have those same people who let's say you're in the OR, and that a surgeon doesn't really the case, surgeons don't have time to share that information all the time. But it helps when someone's there to provide that support to say, hey, you know what, let's, let's do like a recap of this and post it on your LinkedIn or your Twitter. That's where I see the sales rep going, and I see them providing more valuable support than just being an order processor.

Scott Carson  42:38  
We are out of time. Thank you, everybody. Appreciate the questions and I know a few others have questions. We'll be out and back and answer those as best we can. Thank you.