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David Fischel – How to build a successful MedTech company

In February 2017, a leading investor with an active interest in people and healthcare was appointed CEO of a medtech company. David Fischel took a step into a role which he had never done before, because he believed in its mission.

As CEO of Stereotaxis, his leadership has seen a company which was stagnant and struggling despite having leading technology in robotics, revive and see growth in its stock.

In our latest episode of Career diaries by Elemed, David talks with Elena about changing the culture of a company, common mistakes startups make and how to avoid them, the importance of hiring “doers” as part of your team and his vision for the future of Stereotaxis.

With David Fischel at the helm, Stereotaxis has significantly increased its capacity to benefit the MedTech industry with its innovative robotic technology in performing endovascular cardiology and treating arrhythmias. Among its many advantages, Stereotaxis equipment makes surgery safer for patients and more precise for physicians.

Why medical devices?

The beauty of working in medicine and medical devices specifically is that you combine multiple challenges and specialties all in one. On the one hand, you have human biology and medicine which is fascinating, and trying to work to improve that is motivating.

On top of that, when you look at robotics in medical devices, you have a mix of mechanical engineering and electrical engineering and software and the combination of all of those together is fun, exciting and challenging.

And then you have the whole business dynamic. Working in the business of medical devices, combining human biology and medicine with technology with the challenge of running a business is a beautiful combination.

When did you first get exposure to the industry?

My parents are physician scientists. In the ‘90s, both of them gradually transitioned to learning that there was this world where medicine and finance interacted. In 1999 they founded a hedge fund, DAFNA Capital Management, focused on earlier stage publicly traded biotechnology and then also medical device companies.

I worked with them throughout my schooling. At University, I studied math and finance. After graduating, I went to Israel to work in an Israeli medical device venture capital firm called SCP Vitalife, before returning to LA. I joined our firm, with medical devices being my primary focus and I was a portfolio manager for those investments.

How do you go from passive investor to CEO of a company?

“When you’re an investor, you’re looking for situations where the current reality of a company does not reflect its potential. As a passive investor, you want that gap to be bridged through actions not on your own. When I came across Stereotaxis, I was intrigued by this gap and discrepancy that I had seen so far.”

He investigated to find out why the company had such disparities and realized that there had been issues with corporate governance and leadership. He knew that to bridge the gap, a more concerted effort was required than what the company was used to. As a big believer in the companies’ technology and potential, David was elected as CEO and chairman of the board.

During your time as an investor in startup companies, what common mistakes did you see companies make?

Some of the reasons why startups fail:

    • Developing a product that doesn’t have a market need
    • Developing a product where the market need is not substantial enough
    • Not considering in enough detail how the users will actually use it
    • Not thinking about all the potential stakeholders in the adoption of the product
    • Pricing: not designing it at a cost that would be feasible for the market to bear and for the company to make a return.
    • Regulatory issues, manufacturing issues, IP issues
    • Not managing the human element and interaction in the right way

Some of the reasons startups succeed:

    • Sometimes it’s like winning the lottery – luck
    • Most of the time, it’s repeatedly making the right micro decisions every day in the right direction.
    • Make good & smart decisions.
    • Being persistent as you make those decisions.
    • Be directional even in the big decisions.
    • Be patient. Companies are not built overnight.
    • Hiring do-ers
    • Designing a product which solves a market need

How will the Medical Device Regulation change the landscape of the industry?

I Don’t think MDR vs MDD is a complete phase change. Regulators globally, are caught between a rock and a hard place. On the one hand, they have a mandate to protect the public from products that could cause harm or that aren’t proven and on the other hand, they have a mandate to bring to market those therapies that could provide a benefit. Those two goals in some way, counter each other. Regulators have to find the balance between them.

What we’ve seen in the medical device field is generally Europe being more accommodating to devices. A more accommodating regulatory environment is positive in that it gives patients and physicians more choices. It’s negative in that, you can have therapies that aren’t that well proven causing harm until that harm is noticed.

MDR will be more protective of patients, but every time you increase the level of regulation and you increase that burden, it makes it more difficult for smaller companies – there is a societal cost making it more difficult for smaller companies to operate.

Will startups survive?

It makes it harder and it makes it more costly. Again, there’s a benefit to it and I guess that the European regulators probably were looking at the benefit in terms of reducing risk to patients that an unproven device comes to market. The cost is that innovation will of course suffer.

The biggest things to watch out for in Medtech

There are two major trending topics that we see across the industry, especially in Stereotaxis’ area:

1. A preference for reduced invasiveness of procedures which is beneficial both in that it reduces the risk of a procedure and improves outcomes, and secondly it’s beneficial because it improves access to therapy.

2. The transition to a more digital, connected, robotic environment. It’s being used to overcome limitations with better precision, stability, reach, safety and more data is available to the physician through digitization.

Most defining moment of success at Steretoaxis

Taking a company that was static for almost a decade and reenergizing it; the people, the way the customers and the market look at it is the most heartwarming aspect of the job.

Another defining moment happened last year when Stereotaxis came out with the first new meaningful robot in the company’s history which was the Stereotaxis Genesis RMN platform. It’s a smaller device, less costly and is an improvement in robotic magnetic manipulation.

How do you build a strong company culture?

It starts from the top. The culture of a company should be made up of two important factors:

1. Doers.

2. People who have aligned interests and share the view of what the mission of the company is over the long term.

“Those are the two biggest things I’ve tried to make sure happened across the team.” To incorporate this culture, David went so far as changing the system of board members in their company of getting paid in cash to getting paid in stock so that they would be motivated to see the company succeed. Leading as an example, David has never received a salary from Stereotaxis and is paid only in stock.

So, how do you identify if somebody is truly a doer or just claiming it?

“It’s very, very hard,” David laughs. Even CEOs of medical devices companies that have hired thousands of people over their long term careers, say that hiring is a 50/50.

“When you start working closely with somebody, it becomes very obvious who is a doer, and who is more of a talker.”

Doers contribute rather than just talking. They don’t just manage people and tell them what to do. They lead by example by functionally contributing and they have a specialty that is valuable to the company. And this should take place in every part of the organisation.

They are more efficient and have the right mindset; they’re willing to roll up their sleeves and get the work done. They’re not removed from reality. When you behave as if you’re in an ivory tower, it can create resentment from those that are actually doing the work.

What do you do as a leader when you identify that someone on your team is not a doer?

Each case is different. “It depends on the individual environment — the company situation. In some situations you need to make rapid, tough decisions. There are other cases where you need to coach and guide the employee…”

GOAL SETTING

There tend to be two schools of thought concerning goals. One group is set against it and believes that people should go with the flow. Another group firmly opposes that view and has the utmost confidence in planning, knowing what you want to achieve and striving for it. Both schools of thought are correct and that neither is better than the other.

“Either you proactively go out and try to grab something, make something happen or things come to you which is not entirely passive because you need to have the mind and eye to be able to notice when opportunities present themselves to you. Success and growth can happen through both mechanisms which is okay.”

The future of Stereotaxis?

Cardiac ablation is a big opportunity. 99% of surgeries are still being done manually using hand held catheters. There is a lot still that needs to be done in terms of advancing robotics interventional medicine which we are working on such as, making the technology accessible and the therapy better for the physician and the patient.

What does success look like for you?

Success is us transforming endovascular surgery in the same way that Intuitive Surgical transformed laparoscopic surgery. I hope we will see that 85% to 90% of cardiac ablation procedures are being done robotically and then additional endovascular procedures should probably follow.

What’s the legacy you want to leave on the world?

You have a limited amount of time in this world, a limited amount of bandwidth, you want to have as good of a positive impact on the trajectory of the world as possible. So, it’s important to try to use your skills, energy, influence, intellect and time to do as much as good as you can.

Right now I try to do it by pushing forward medical innovation so that we transform the way medicine is performed into a smarter, more effective, better way.’

Erin McEachren – The importance of giving (and receiving) constructive feedback

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In our third episode, we were excited to have Erin McEachren as our first female guest. Erin has been a go-getter all her life, from being part of the Canadian Alpine Ski Team, graduating from the University of Colorado on an NCAA Division 1 Athletic and Academic full scholarship, to where she is now; Commercial Vice President of NuVasive, Europe.

In this episode, Erin talks to Elena about how she became the Vice President of a major player in the MedTech industry and what it takes to be a successful female leader. They also discuss how giving (and receiving) constructive feedback can help you grow and the importance of work-life balance.

The insights Erin shared are all about how to build a career, without losing sight of what’s important in life.

Where it all began

At the age of nine, Erin developed a disease in her hip and had to have serious orthopedic surgery which put her out of school for a year. Fortunately for her, the surgery was a success and she was able to heal and go back to being active.

Having a successful surgery stuck with her and gave her an appreciation for medical devices, good surgeons and GPs without whom, she wouldn’t have been able to continue having an active life and later receive an athletic scholarship for the university of Colorado. This experience sparked her interest in joining the medical industry.

How to choose a career

Erin studied biochemistry with a minor in physiology. Going into university, she wasn’t one of those people that had it all figured out. It’s a challenge that a lot of students experience, especially with the pressures of today, but with the right strategy, it’s possible to navigate that uncertainty.

It’s important to go to school and focus on doing what you love – the right things will come out of that. Choose a subject that you’re passionate about and be open to other things along the way.

Erin is a big believer in variety – it’s important to diversify. Don’t go on a singular pathway too early. Try not to pigeon hole yourself into one specific role type, and try multiple careers. Great experience and learning comes when you step outside your comfort zone. Having multiple careers doesn’t necessarily mean job hopping – it could include working at different positions within the same company.

From Grad to Commercial VP

Right out of university, Erin got a job working at Stryker. She got to go to various ORs and geographies and be a product expert which gave her a lot of accountability at a young age.

Early in her career, she spent time with the best marketing and salespeople and that was one of the things that really shaped her. She was able to see how different people have their own authentic style of leadership which showed her that you don’t have to fit a certain mold to be a commercial leader or a marketer. As long as you’re accountable, strategic and build trusting relationships, you can be successful.

After her marketing job, Erin was in sales for 3 years, and then advanced to a leadership position which has seen her work all over the world – most recently in the Netherlands.

One key factor that she attributes to helping her get to where she is now was having a sponsor which shouldn’t be mistaken for mentorship. Unlike a mentor who tends to be more of a guide, a sponsor advocates for you.

How to choose a sponsor

A sponsor is a person who raises your profile and supports you, when you’re not in the room. There’s got to be an affinity. You may have a list of people that you want to be your sponsors but you have to have chemistry. They’ve got to believe in you.

You need to trust them and they need to see you being accountable for about a year or two before they’re ready to speak on your behalf. They need courage and conviction to fight for you.

What do you need to be a successful leader in a big organization?

    • Strategic – a good problem solver and a good thinker.
    • Accountable – can deliver the right results.
    • Articulate – when you can’t deliver, you should be able to explain why and get a plan b and c in place.
    • Be able to influence through metrics and work cross-functionally with your peers to help business with ROI.
    • Be able to generate trust in your relationships.

The numbers…

How do you influence through metrics? It boils down to being able to be a respectful person and translate your opinion with facts and get to an endpoint and solution. At times this may mean having the courage to disagree but in a polite way or to encourage the right result.

Working in different geographies and cultures will help you acquire the mindset for being able to operate in a global role or in a regional role or in a country role because they require different perspectives and levels of interaction.

Other important skills are being able to influence and manage your stakeholders, your emotions and energy.

As a female leader, do you take a different approach to your male counterparts?

Yes, there’s a time to lean in, but it’s important to know when it’s time to lean out.
It can be a strength in leadership to be able to show emotions – it’s all about reflecting what your team and colleagues need in that moment.

How do you get feedback from your manager?

It requires building trust which over time will help you get to a comfort level. It also helps to mention a couple of things that you know that you’re doing well in and then mention where you’re struggling and ask for feedback in those areas.In the same way, it helps to come prepared to ones-to-ones and ask questions like,

    • “What can I be doing  better?”
    • “What do you think is getting in my way of being even more effective?”

If you ask good questions, you’ll get good information.

How do you get feedback from people that you manage?

It’s important to get feedback from people that you’re managing; being approachable and having an open door policy is one way to do that..

The higher the leadership role that you have, the less open that people you manage will feel, so take the advantage of engagement surveys to temperature check how you’re doing.

When you’re hiring, pick people that you feel will challenge you and be honest with you, because it’s a risk to the business and eventually patients if your leadership team is not able to communicate honestly.

What about criticism?

What I have learned is to ask better questions and not make assumptions right away like, ‘Did you mean that?’ or, ‘What did you mean when you said this and that?’ Because as humans, usually, it’s very easy for us to jump to conclusions. It’s easy to think that someone is criticizing me when maybe they’re not.

Work-life balance

For Erin, having a work-life balance has become increasingly important and she recognizes that balance is different for everyone. Erin is a big believer in her morning routine:

    • 5:30: Wake up
    • 6:00-6:45: Work out (jog/yoga)
    • 6:45-7:30: Reflect/Meditation/Mindfulness
    • 8:00 : Ready for work

Top tip: don’t look at your phone straight away in the morning, especially regarding work related matters until you have your mind in the right place.

Advice that you would give your younger self

    • You don’t need to do everything at once. There’s lots of love for you. Let your passion drive you and good things will happen
    • Don’t let yourself feel pressured by time, enjoy the moment.
    • Don’t be ashamed to say you don’t know what you want to do, especially after high school.Take a gap year, travel and you’ll figure it out.
    • Don’t rush things
    • Don’t take yourself too seriously

Erin’s legacy for the world

I hope that I can leave the work with a lot of treasured & trusted relationships.
To be remembered for someone who treated people well and always did the right thing.