Show Notes: All items in bold are questions I asked, or thoughts I have inserted post podcast.
March 24, 2019
Episode 2 with Matt Sweeney
Google search Medtronic peripheral vascular
Intro: Hello and welcome to another podcast episode for InsideMedDeviceSales. Today you're going to meet Matt Sweeney. Matt is a highly experienced, very clinically sound rep. He got his start in healthcare sales back in 1994 where he was selling billing software and medical supplies. After four years of doing that, he was able to parlay that into his first medical device sales job where he was a territory manager at CR Bard. Following that, Matt had several positions as a territory manager, a district manager, and a regional manager at companies like Abbott Vascular, Medtronic and Fox Hollow. Fox Hollow is an interesting story because it led Matt back to where he is today. Fox Hollow was acquired by a company called EV3, EV3 was subsequently acquired by Covidien and then Covidien was acquired by Medtronic and that's where Matt is today as a peripheral vascular territory manager in Indiana. So without further ado, let's jump in and find out what has made Matt so successful. Ladies and gentlemen, Matt Sweeney. Matt, welcome to the podcast, I appreciate you being here and participating.
Matt: Sure, no problem.
Q: So why don't we just jump in by you going back and just tell us a little bit about how you got started in sales, not necessarily medical device sales, unless that was your first sales job, but just how you got into sales.
Matt: Yeah, so I grew up around sales. My Dad has been a lifetime salesman. He worked for Champion, the apparel company, for a long time and then started his own distributorship and his office was in the basement and my mom was his secretary. So I just sort of grew up around sales. And so when I graduated from the University of Missouri with an English degree, my thought was I was going to go to law school and I decided not to do that and just started looking for sales jobs. My dad had a friend who was a regional vice president of a healthcare company in which they sold Medicare billing software and back in 1994 this was new stuff. So Medicare billing software in a Medicare billing package in order to distribute their medical supplies into nursing homes. So you're talking from a supply standpoint, we had 15,000 products anywhere from adult incontinence products all the way to catheters to you name it. And we would sell that at a low price as long as we could sell our software and our Medicare billing package to them. And so my first job was out in Phoenix, Arizona, so I packed up and moved as a junior sales rep back then and I was just running around doing all the grunt work, you know, computer installs, the accounts that were way out in the middle of nowhere. Here is an instance where a junior rep or an associate rep position was used as a starting point. For many, this is a ticket to the dance. There was a couple of them on Indian reservations, wherever the senior rep didn't want to go is where I went. And I reported up through him. I kind of had my own little mini territory with a number, but you know, by and large it really resided underneath him, that's how I got my start in sales.
Q: Okay, so you were not necessarily in med device but you started off in healthcare. Were there any takeaways from that first job that you were able to carry with you and use going forward?
Matt: Other than some great sales stories from the guy I worked with, yeah, I think it was really a territory management role. I mean the territory is the entire state of Arizona and southern Nevada, which is Vegas, so really learning how to set your schedule. It wasn't like back then they told you, or at least the guy I worked with, "you need to go to this place, this place and this place every day." You kind of had to figure it out. And this is back before the Internet, so you would have to look up in the yellow pages the different nursing homes and phone numbers. And there was a lot of times you would just cold call in a nursing home and start asking for names so you can see who you could get in front of. And just really kind of managing your time. And you know, my first two years out of college I didn't know what I was doing. I mean, you're just a lot of times getting in your car and driving because there's a nursing home in Pason, Arizona and trying to figure out, is it worth me spending time here or not? And you know, that was really the takeaway. And then, the guy I worked for was in his early forties at the time, was really kind of burning out on his own and never wanted to leave the house or really work. And I just remember thinking, I don't want to get to that point in my career where I just don't even want to work anymore. But I think what that job really taught me more than anything else was just sort of the people skill interactions, managing a territory, looking at numbers. I had pretty broad discretion on pricing. So back then you'd open your price book and you have five different prices you could give a customer. And we were also paid on margins and percent profit. So you can kind of see right in there what you needed to sell and get to be on top of your comp plan to know if I sell these toothbrushes at 8% profit will she also give me her adult incontinent product, which maybe carries 10% profit. Since one's more expensive than the other, you get more gross profit dollars, things like that. It also gave me a good understanding of the healthcare system, like Medicare and knowing how all that worked, and how many loopholes there were in Medicare and how just sort of inefficient it was, so just a good broad knowledge of just what healthcare was. I mean, I had no idea, we were going through training and they're trying to teach me what the difference was between Medicare A and B. And I'm looking at it, I'm like, well then what's Medicaid? Well that's over here. And it took me like 45 minutes to understand what the heck that was. But they had really good sales training, the name of the company is Redline Healthcare. And they did have the traditional, you go in for a week, you come back, you go back in for two weeks, there were tests every day. If you were failing you were going home without a job. So it was a real introduction into big company sales. That's probably what I got from it more than anything else.
Q: What made you decide to start looking at other opportunities?
Matt: I got promoted, about a year and a half, almost two years into the job and the promotion was having my own territory. And that job was in Atlanta, Georgia, so I moved to Atlanta. In between there I got married, so my wife had moved out from Kansas City and then we moved to Atlanta. Ironically enough, the guy I was working for quit three weeks later and I could have still been in Arizona rather than go to Atlanta. So I went there and took over a really good territory. I had the entire state of Georgia, which is the biggest state east of the Mississippi, with no help. I mean it was just me and it went well, it was one of those things, once you got sort of south of Atlanta, if you weren't from Georgia, it got to be tough, especially in a business like that. I mean, nursing homes from back then were more mom and pop organizations. I mean they were family run. And so that was tough. But you know, I felt like if I could be successful in a couple of areas that I wasn't from that that's got it in some way, shape or form, make you better. And to be honest with you, I never even thought about the device world. I had a friend in college who, his brother was a pacing rep, and back in the mid nineties a lot of those guys had biology degrees and premed degrees and he was in his early thirties making a ton of money and driving a big fancy car and all those things. I thought that was cool, but I wasn't from an educational standpoint or even an aptitude standpoint, able to have done that, or at least I didn't think I could. And so I was talking to a manufacturer rep because since we were a distributor, you would deal with these manufacturer reps. And this guy I got to be kind of friends with, he was probably 10 years older than me, maybe a little older than that, maybe 15. We're having a cup of coffee one day and he worked for Kendall, which I don't believe is even around anymore. And he just looked at me and he goes, how old are you? And I said, I think at the time I was like, maybe 26, 27. He goes, "Why have you not gotten into device sales?" And I said I don't know. And so he got me in touch with the recruiter and I interviewed for Bard, CR Bard. And back then a really good entry level device job was GI. And so, essentially. you're selling biopsy forceps and polypectomy snares and you're going into colonoscopies and upper GI cases every day. And you're really competing against Boston Scientific, Cook, companies like that. And that's really what got me in the device thing. And you know, back then it was sort of like, and probably a lot like it is today, you know how you're going to go do that for two or three years and then you're going to try to get in the cardiovascular space somehow. And that's really how I even got into device sales. It was just a cup of coffee with a guy telling me to broaden my horizons.
Q: So it was a recruiter though that made the connection with you and Bard.
Matt: Yes. So like I said, I just sent my resume and I think that one of the selling points, if I can remember back from the recruiter, that I didn't come from the pharmaceutical side. I kind of avoided that a lot of ways because they were hiring lots of ex-athletes and it was almost like you had to be 6'2" 190 pounds and be an ex-athlete to even get into like at that time, I guess with them like Merck and Pfizer and places like that. And I'm neither of those. I mean, I'm a 5'8" 170 pound guy that just works hard. And so I didn't have any of those, I didn't have those physical attributes to get into it. And so I never did. And the device world, Boston Scientific would hire a lot of that. So I had five people I competed against just in the Atlanta area. Three of them played football at Georgia, one was a cheerleader from Florida and one was from Georgia State or something, which is right in Atlanta. And that's who I'm competing against, right. So I'd walk in with my suit on and these people all look like supermodels and, and so I'm trying and they had better products and better marketing and all those sorts of things. But I think from the recruiter standpoint, it was that I knew how to run a territory. My job was really truly what a territory manager was. You were selling, but you were also managing a big book of business. You're working with profit margins. You were dealing with selling a lot of things like our Medicare billing service and software packages in order to get the bulk of your business. And so there were some things that I think helped me over some of the pharmaceutical reps.
Q: When you were going through that interview process with Bard, can you remember anything that stuck out as being different than any other interview process that you had gone through before or did you find it very similar?
Matt: Okay, so this was real old school. I mean this was, you are developing a business plan, you are putting that into print, you were going through multiple interviews, you had a psychological interview on the phone, lots of pretty stressful things. I mean, a ride along in the field with a rep that was kind of trying to mess with your head a little bit, trying to trap you into saying things you didn't want to say. So your guard really, really had to be up and back in those days the device world was a rough place. I mean it was extremely competitive. It still is, but I mean really competitive. People had no qualms about calling you out, even in an interview process. And so the funny story about that, as soon as I went through the psychological test, I remember the last question they asked me, and this is like a 90 minute over the phone thing and I just kind of had it and this actually got me the first sit down interview, is he asked me, he goes, what does a bottleneck mean to you? Basically, and that's it. What's that mean? Like a bottleneck. Like you can't get something done that's bottlenecked. I said at this point in the interview, a bottleneck means to me is a very cold, tall beer. And the guy started laughing, well, my boss who ultimately hired me, thought that was funny. So he got me into the interview and it was a very stressful interview. It was things like, he had asked me, I remember he asked me one time, what makes you think you can be good in sales? Why have you been successful? I said, "well I'm really good at reading people and knowing exactly..." He just interrupts me and says, "okay, you sat down with me now for 15 minutes, read me, what am I all about?" Thinking to myself, man, I should not have stepped into that. That's a really dumb thing to say. So I sort of gave him some general answer about being very driven and results oriented and you know, anybody could have said it. But when I went to my final interview in Boston, I fly in and spend the night and then the VP of Sales picks me up in his car. So I got like a 40 minute drive in a car with a guy before I even start the interview process that I'm going to be with five people all day. And back then when you would get sales awards, you got trophies, things like plaques and trophies. Things like you're in a grade school, sixth grade champion of the Catholic League, whatever, and I brought all those with me, the ones that I've won at Redline Healthcare, there's like maybe eight of them and I had a duffle bag, the actual trophies, because the recruiter told me you better be able to prove you have them. A lot of times you didn't even get a letter with it. You know nowadays they kind of send you a letter or something you can stick in your attaboy files. I mean I had to go through the metal detector at the airport. They're like, what the hell is this? And I come in to the interview in his office and I've got my briefcase and a duffle bag and we start talking and sure enough at the end he asks, how can you prove to me you won these awards? I just unzip my bag and I started to pull these things out and set them on his desk and he about fell out of his chair laughing. He goes, you really brought these? I was like, how was I going to prove to you? I guarantee I didn't go to the local trophy shop and just have these things made.
Pat: That's awesome.
Matt: But I wanted the job so bad, and I was smart enough to listen to people. I knew what I didn't know. So if somebody told me this is what you gotta do to get the job, then that's what I was going to do. And then through the interview process, the thing that I did, and I don't see a lot of candidates doing this nowadays, I closed every single person. I mean, they had me interview for a brief moment, and this was no joke, with the VP of Sales’ secretary. We started talking because her son grew up with Tom Glavine who pitched for the Braves. He's in the hall of fame and they were really good buddies and so that was kind of our connection. You know, Tommy Glavin and she was friends with them and all this kind of stuff, so we started talking and really her job was to go back to the VP of Sales and say, you know, this guy's a nice kid, you should give him a shot, he's not arrogant and all that kind of stuff. But I even closed her, hey, can I have your support? So that's what I was doing the whole way and ultimately got that job over somebody who did have device experience and that's how I got in.
Pat: And the rest is history.
Matt: The rest is history.
Q: Talk to me about your current role. What are you doing?
Matt: So what I'm doing right now is I'm a sales rep for Medtronic peripheral vascular. So I cover pretty much, well the entire state of Indiana, except for Evansville and northwest Indiana. And I actually go all the way up into Flint, Michigan, where I've got a rep, they kind of have us categorized as SR sales rep one, two, three and four, four being the most tenured, one being the least tenured. He's an SR one, I'm an SR four. We kind of split the territory, 70-30, and I've got a clinical in Toledo and two here in Indianapolis that I manage. And so that's what I've been doing for the last year.
Q: You said peripheral vascular. For those that aren't familiar, what does that mean?
Matt: So peripheral vascular would be any sort of stenosis or blockage that would happen in arteries that are not the heart or the aorta for what I sell. So basically all the arteries that are in the hips, the thigh, below the knee, in the arms, the carotid artery, which is the artery that goes up to the brain. So any sort of product that would open those up or keep them open. So that'd be balloons, stents, drug coated balloons, and atherectomy devices.
Q: You have been in this space for a while, but is there anything about the role that surprised you, maybe going back to when you first got into the peripheral vascular space?
Matt: Yeah, so I got in the peripheral, I guess the vascular space, in 2000, that's what got me to Indianapolis. And back then, I was selling a device called the perclose device and I was the first rep in Indiana for that. That device closes the artery and the groin after a heart cath, peripheral vascular caths, so basically the doctor has to go in the groin through that artery to access either the heart, but really the entire vasculature. And when that's done, you've got a little, about a 2.3 millimeter, hole and my device would actually, percutaneously through the skin, tie that hole up so the patient could get out of the hospital quicker and the staff wouldn't have to hold pressure on it. And so back then, nobody really negotiated price a whole lot. You would use your trunk stock as in, you would bring the product in and you'd get a PO pretty much by the end of the day. Nobody really balked at buying some stuff in for an evaluation. And here 18 years later, 19 years later, those things don't happen. Bringing trunk stock in, if you're not on the contract, you can forget about it. Access to physicians, back then all the physicians had their own private practice and they really could dictate what they wanted. And if the hospital didn't give it to them, they could go to another hospital. Now those guys are all employees of the hospitals and they don't have as much power to fight for things they might really want. And so that process has really changed. You know, a lot of the young physicians now, because they're employees and they get paid really well, a lot of the younger guys are more into lifestyle than the older guys. And the older guys were working 80 and 90 hours a week all the time because it was their practice and that revenue they generated paid everybody from the secretary in their office to the PA and the other partners. Now the hospital, much like the rep, gives them quotas. How many surgeries they have to do, how many hours they have to bill, which are called RVUs in that world. And if they get six weeks vacation, they're taking that six weeks, why not? And so that part has changed a little bit. These guys are coming out with more debt than they've ever had and they're probably more educated than they've ever been, but it's just a different, almost a kinder, gentler world than it was way back then when these guys would yell at you in the Cath lab or the OR, I mean it was not uncommon. Now everybody's kind of friends, so it's a change.
Q: Keep that in the back of your mind, because in a little bit we're going to talk about some crazy cases and some things that didn't go as planned. So who are your customers?
Matt: So currently my customers are interventional cardiologists, the vascular surgeons and interventional radiologists. But it also extends to the Cath lab manager, the lead techs, and then also whoever the director of purchasing is or materials management.
Pat: I'm so glad you said that. I think that's one of the biggest changes I've seen in the space. And I was going to ask you that same question. Just the role that people play now, I remember when I first got started in med device sales, I didn't know where purchasing manager's office was. I didn't care, I didn't need to know. And now, just like you just said, those people are all heavily involved in this process.
Matt: Oh yeah. Everything from where you've got your vendor sign in computers and things that if you don't sign in or sign out when you leave, you're hearing about it. And that part has really, that changed probably, I don’t know, over five years ago with the Vendormates of the world and the RepTrax and all those sorts of things. What is kind of crazy to think, you know back when I was at Perclose in the early 2000s one of my roles is we would, I would scrub in to these cases at the end and we would actually follow the patients up on the floor and check their groin to make sure there wasn't some sort of complication with the close, be it a hematoma, which is basically the arteries leaking underneath the skin. It creates this huge bruise which could cause trouble and we would go in and do that. We do it around the clock. And so I would inservice the night staff, the morning staff, everything else and they would want me to go in the patient room at two o'clock in the morning and check someone's groin, which I would always bring a nurse with me. But there was no checks and balance. You just kind of like walked in the hospital and there you went. They didn't know who the heck if you had TB or which now you get tested for it, you have to prove it, or you had your flu shot or anything. And so, that part of it has always made sense to me even though it's been kind of a pain and that just takes the liability off the hospital and the companies. But you're right, I mean, just that process that's nonclinical and those people that are involved in it that can ultimately kick you out of a hospital if they want to. Where you can't even get in is, and the whole contracting piece. And in a lot of times you're calling on somebody who didn't go to school and didn't get into health care to become a contract analyst. Now there are a lot better than they used to be, but a lot of times you're talking about people that were nurses or techs and they just kind of kept getting these battlefield promotions and they're trying to negotiate a contract and they don't really have negotiation skills. And that can be a little tough, but it's gotten better. In your big healthcare systems, these people definitely go to training and classes and things like that, but it's much different than it used to be for sure.
Q: When you think about your customers being the physicians, the administrators, the OR managers, how would you describe your interactions with each of those? How does it change when you're having a conversation with a physician versus an administrator?
Matt: Well, the physician is, for the most part, purely clinical. Although, every cath lab, every group usually tags a doctor to be sort of that contract and the liaison with the vendors and also internally within the hospital so that everybody's kind of on the same page. But again, 90% of the time when I'm around a physician, it is talking clinically about my products and where they need to be used. When you go to the materials management, and again it's gotten a lot better the last couple of years, but you're really just talking, I mean they really don't know if your product is any different than anybody else's. They look at price and I've always tried to keep them in the loop clinically about what my product does versus somebody else's and why it might be more expensive than somebody else's, but that doesn't really help if you haven't got the physician clinically sold on it. Being able to communicate both clinically and economically is critical. The most successful reps not only can do this, but they are extremely successful at it. Because eventually that contracting person is going to go to the doctor and say, Matt Sweeney came in here saying you wanted this thing for a couple thousand dollars. Do you really want it? And you hope you've done your job with them clinically that he will at least go to bat for you. And so those two things are a lot different. You have to be a lot more patient with the contracting folks to kind of go through what you're doing. And understand that when I'm calling on an interventional cardiologists or vascular surgeon or a radiologist about the peripheral vascular, that's all I'm talking about. And they're only doing those procedures or maybe a couple others. Right. So it all kind of runs together. You go to purchasing, they may be dealing with the guy they just met before you may have been a coronary rep and they're trying to understand that, it may have been a pacing rep, it could have been an orthopedic rep or trauma rep. And so you're trying to make them sort of understand your little piece of the pie and you gotta be patient with that because they a lot of times anymore are not clinical people and they just don't, they don't understand that.
Q: What would you say is the most challenging part of your job?
Matt: I would say the most challenging part is different on different days and different with different hospitals. I would say it's extremely competitive right now. We have a lot of players in the peripheral vascular space and it didn't used to be that way, but we've had so many buyouts and companies buying different technologies that with my atherectomy device where 2005 to 2007 we were the only one in the country that had it. Well now there's five or six different atherectomy devices. With stents, there were probably three when I started selling stents and now there's like six and there's six different balloon companies and there's three different drug coated balloon companies, three different drug coated stent companies. And so everybody's looking for their time with your customer base. Everybody's looking for lab time, you know, which sometimes doctors call you in for cases specific to those cases. And if that happens you're in. But many times you're scheduling a lab day through a lab manager and they kind of dictate which day you get there. And if there are a lot of cases going on that day, great. If there was not, then you're hosed. And so just getting time with the doctors. And so that to me is the biggest challenge because each lab is like a little mini petri dish of politics and who kind of likes who and who doesn't like who, and there are people that are influential in that lab that hold no management experience and you've got to be able to, or a position, and you've got to be able to figure out, okay, this person right here is an influential person in these cases. I got to get to know them and just observing how doctors are interacting with people, who's having a bad day that day, where you just have to stay out of the way. But if you get that access cut off, you're going to have a really hard time selling your product. And I think that's where it comes down to sort of like for every five minute conversation with a doctor that's meaningful, we probably got two hours of work put in to it to be able to formulate a five minute conversation. Because it could go any different number of ways for that guy. But it's just getting that lab time is to me the most challenging. And then price pressures that are starting to happen.
Q: With the lab time, are your products still being used if you are not there?
Matt: Yeah. Yeah. Sometimes, it depends. There's a couple of hospitals in town where we have the contract, but in the medical device world, by and large, you might sign a one year or two year or three year deal and that could get blown up in six or seven months. And I had that happen with one of our major product lines here in town. We negotiated on a drug coated balloons, which is probably 40% of my territory. We've got the third or fourth largest drug coated balloon territory at Medtronic. And we signed a deal, dual source vendor deal, and six months later, once all the prices were set, they let a third player come in and they rebid everything. And then now all three players are there and they keep reminding me that I'm more expensive and I keep telling him, yeah, but that's after everybody knew our pricing and it doesn't really matter, right? I mean, it's not like I'm going to win that argument. So in that situation, I just have to be able to clinically sell my product and kind of clinically sell myself. That if they're going to deal with three reps during the course of a week or a month or a year, that I'm one of the three they want to deal with the most because I seem to know what I'm doing. But that stuff gets very, very frustrating because sometimes the products are used when you're there and only when you're there and sometimes they're used when you're not there. And sometimes it's usually a combination of both.
Q: With all of the competition, how do you differentiate yourself, and you don't have to give trade secrets or anything, but how do you stand out when you're not there? How do you do that?
Matt: Well, it's gotten a lot tougher. You're trying to find these guys and most of them are pretty good on text in terms of, I'll send different papers via text or email. The most effective is obviously getting in front of them. We try to do everything from getting physicians to training programs where a peer can tell them about our products and why they're better. But mostly the reps that do really well in this business are just uber prepared. And so when they get the five or 10 minutes with a doctor, just by asking a couple questions, if you've been in this business long enough and you've talked to enough people in the lab, you kind of know what's making these doctors tick. You gotta be able to ask a couple of quick questions to be able to get right to the meat of it and present it in a way that's really, really simple yet addresses the complexity of what they might be thinking about as they're trying to treat a patient. You know, these patients are really sick and they're, at least in my world, we're dealing with peripheral vascular disease. You're talking, most of these patients are 75 years old, smokers, diabetics and obese and they're rotting from the inside out. And so you're trying to do is keep a vessel open for a year or two years so that other doctors can take care of those other comorbidities. And so just trying to hone in on what it's going to help. And my businesses is not a one time hit and you've got it. I mean, sometimes these conversations, it takes you every week for six weeks to finally get the guy to give you a shot. It takes some time because they've got relationships with other vendors as well. And so, I don't know if that answers your question, but that's how I've just tried to differentiate. And then I will say this, I managed for 12 years before I decided to just become a rep and make more money and have less stress and I have always told my reps, and this used to drive me crazy when I'd inherit a rep that would show up late for the first case. So let's say you got 7:00 AM case, well to me, 7:00 AM means be there by 6:45 and that just goes back to when I got in this business and I don't care if the patient is just getting on the table at seven or they don't start till 8:00, they're habitually late. You're getting there at 6:45. I can't stand it when reps are showing up at 7:15, 7:30 because they're always, now granted if you've got a traffic jam or if it's a 2:30 in the afternoon case and everybody's running late and you get there at 2:45 that can happen too, there is no excuse because nobody's ever gotten in trouble for being early to the first case. That's a time where even if the patient's not as a table, you can kind of BS with everybody, talk to everybody, drink a cup of coffee with them. But there's a lot of respect that goes into that. And I think that the reps that are really putting in the time, these doctors and the staff recognize that because they're putting in a lot of time. I mean they’re putting in a lot of time and in my world, I don't have to take call, but those guys are all taking call. So if you come walking in there as a peripheral vascular rep and be like, Oh man, I'm really tired. It's like they're looking at you like, really, you know, you're making all this money more than me, and I came in at two o'clock in the morning and I will not go home until my shifts over, and I'm on call again tonight. So it's one of those businesses were the hardest working people generally are the ones that are going to be successful. I've seen people that are, you're talking to one of them, I'm not very smart, I'm not very talented, I'm not very good looking, but I've had a pretty good career. It's just because I outwork everybody. I mean that's just what I try to do and it's showing up early and it is working late, and the last three Fridays I haven't gotten home before 8:30 at night and I'm with customers who would probably use my product if I wasn't there. But you know, if they're going to hang in the pocket that late and use my stuff, I’ve got to at least stay there and show him I'm committed. So I think the reps that are willing to do that and do it in a way that's gracious, pleases and thank you's go a long way, believe it or not. Being positive when you walk in there, you're the one smiling. Not in a phony way or not in a way that you're sort of distracting everybody, but you're just a positive influence when you're in there. Those people go a long way in this business they always have and that'll continue to happen. I'm actually, like I said, I've seen some people who have gotten away with just doing a bad job in a case or something like that because they're likable, hardworking people and they seem to, you know, they're willing to give you another chance if you screw up.
Q: You mentioned doing something wrong in the case. Can you describe what your role is when you're in a case?
Matt: Yeah, so it depends on the type of procedure. In our world, probably 20%, maybe 15% of the doctors are doing 80 to 85% of the work. So those guys from a clinical perspective are, you're not having to talk to them a whole lot other than you're just talking shop approaches. They're always interested in what's, what are you seeing out there? And just being able to talk about that. But a lot of doctors really struggle, you know, and so in my world, if a physicians doing 15 to 20 let’s say legs, so that's the arteries in the legs, a month, that's real, real busy, that's a busy guy. Most are doing maybe two or three a month. And so every time you'd go in there, it's kind of new to them and you might have to tell them everything. With us, they have to access the groin with a sheath and that sheath is just a little tube and they then have to get a wire, which is anywhere from 14 thousands of an inch to 35 thousands of an inch, which is small, past the blockage in the leg and that wire is what all the devices go over. It's like a train track. And if that wire can't get beyond that blockage, your device can't get used. They can't open up, they can't even do anything with the patient. So a lot of it is just helping them, telling them what kind of wire to use. I don't sell wires, but I tell him which wires I've seen that worked well, which type of sheaths work well. There are other little crossing catheters that aren't therapeutic, but they might help cross the lesion and really trying to get them to be able to get the access part of it to where you can now get to your device. And one of the biggest parts is knowing when your device is not going to work. And that can be, my top guys could treat this lesion with my device and I wouldn't worry about it. This guy, he's never really used it and only does a couple of month and I'm just not going to take that chance. Number one, it could hurt the patient. And number two, if they have a really bad outcome, they will never use your device again or have you in. And so there's a lot of consultation over the patient about whether this looks like a good case or not. Now, hopefully you've done your job leading up to that by showing different pictures and things where, hey, this is a good spot for our device, this is not. But if you can keep doctors out of trouble with your device, you'll kind of always have a friend. So that when you do get an opportunity to walk them through a complicated case where your device is going to shine, they'll never forget that. And I tell guys all the time that are evaluating, especially in my atherectomy device, which is the most complicated one, if you have me in here for your next 10 cases, five of them, maybe seven, we won't be able to treat, but three to five, we will. And that might be the first five to seven. It may be the last five to seven, but we got to make sure you're really getting good outcomes. So you're comfortable with the technology, you're comfortable with your technique. And then, getting guys like that to a training program. But my role would be, dependent on the doctor, but probably 60% of the time is really kind of walking them through, at a minimum my device, and at a maximum kind of everything.
Pat: Well, it's interesting that you said being aware of when your device won't work. Very early on in my career, somebody made the comment to me, I think it was one of my trainers that said, when you go into a case and everything goes right, anybody can do that case, but it's when things start to hit the wall that you can really distinguish yourself and you kind of go to a new level with that physician if you're able to hang in there with him or her and get them through a challenging case, because not everybody can do that.
Matt: That's exactly right. Especially if there's a complication with your device that's unforeseen. And just making sure, you have got to be calm and making sure everybody else was calm. Because now they're looking at you as to what are we going to do? And I think that's where you can lean on some of your bigger customers. You're waiting between cases or you're talking during the case and how would you, or over dinner or whatever, how would you handle this? How do you handle this? And taking some notes, because your top users are still not in as many cases as you are. But they've been able to figure out what makes things work for them and they're smart enough to kind of listen. So it's got to be a combination between what they're going to tell you and then what you've observed. And then things you can read. I mean nowadays, gosh, you can Google, how do you take care of complications in the peripheral vascular and there's just all this stuff pops up. And hopefully you work for a company that has good training programs so that you can reach out to those people. But like you said, you've got to be able to step up when things go bad and sometimes you can't. I mean, sometimes stuff happens and there's not a lot of answers, but I've only ever been in a situation one time since I got in device sales where there was a complication they couldn't handle and the patient had to go to surgery because of it.
Q: That's a good segue. Let's talk about the strangest or most bizarre, unusual, unexpected case that you've been in. Can you think of one?
Matt: You know, I've been in a lot, the one that I think of, and this is a good example of not being prepared and not trying to wedge your device in to a place where it shouldn't be. But there was a case here locally. When I worked for a company called Fox Hollow, we were a startup company and we had atherectomy device that nobody else had and it was new. Everybody was using stents and balloons back then to treat the artery in the thigh called the superficial femoral artery or the SFA. And you had to really clinically be on your game. I mean you had to really, because it was so new and we were a startup company, you have like three days of training. You had to really have been in some big cases in your life. So I came from scrubbing in at Perclose, then I went to Medtronic and sold bioprosthetic open heart valves and I had been in some pretty big cases. And so this was new. You're talking about launching into a market. So if anything goes wrong that spreads like wildfire. Well, we hired a rep that didn't have a lot of experience and they had a lot of pressure on them to start selling this device and they put it in a spot that it should not have been put in. Well the lab that this was happening in wasn't my territory, they knew me and they called me and they told me, hey, can you get here? We got this case going on. And so I thought something happened where the rep couldn't be there or the patient was on the table, so anyway, I just went. And I walked in the control room, which is where all the monitors are. So you've got the cath lab, which is on one side of the glass with all the monitoring equipment where the patient is, and the other side is the control room where all the little TVs are and computers and there's like eight people in there and two of them had suits on. I come walking in, I'm thinking, what's going on? Well, there's our inexperienced rep, she has the how to manual open in the control room and she had been going back and forth, reading the how to manual, was pulling her mask down over the sterile field and talking, not just talking through her mask, and basically had knocked off a piece of very hard calcium in the upper part of the SFA, and it had gone down and occluded all the arteries below the knee. So now we went from a noncritical situation to a very critical situation and the patient could lose their leg. And so I come walking in and the guy's like, are you her boss? I'm like, no. He goes, I don't care who you are, you get her out of the room and you go in there. And so she didn't even know I was coming. I tell her, you’ve got to get out, we'll talk later. And basically I had to break the news that guys, we don't have an option here. We can't get that big piece of calcium out. You're going to have to take that patient to surgery. And they had to put the patient in an ambulance, take them to another hospital that actually had an operating room because this was a suburban hospital. And that patient they had to open their leg totally up. So they'd cut the patient basically from right above the knee, down to the ankle, go into the artery, dig out the calcium, it's a big surgery and that was it. And the next thing I know, a couple of days later I was down at that other hospital where the surgery happened and I ran in to the surgeon that did the surgery. And I was friends with the guy because he was part of the cardiac surgeon group that I was calling on the last three years. And I just had become friends with him and he was yelling at me in the hospital lobby about my reputation and what happened. Because at the end of the day, the only sales rep name that went in that book is the one who was the last one in there, and that was me. I didn't start the case, and I had to kind of calm him down and everything else, the patient ended up doing okay. But what happened is as these companies put pressure on you to sell devices, which they will, especially when you've got one product like we did in the startup world, you have to still keep your clinical integrity. Because what I had to say was our device should not have been used there and it shouldn't have. I had to throw the rep under the bus in order to protect the integrity of the company, my integrity, and really a device that worked really well when it was used in the right spot. And unfortunately, this rep, she was let go probably 60 days later, did something. And by the way, this group in town has never picked that device up ever again. That was 2005 so that just shows you, they use other products of mine, but they still talk about that case. That doctor is still around. So my point of telling everybody that story is that is one where there was no answer for that and had the rep been more prepared, had been willing to walk away from that case, they may have gotten the next 10 cases from that guy. But to just sell a device to sell the device or not know where it's not going to work ultimately got this rep let go and we never got the business, with that type of device in that group.
Pat: I've found that some of these people have very long memories, rightfully so.
Matt: Absolutely. I've had a device break off in a patient, so same type of device where it's got a long nose cone at the end of the catheter and that's soldered on to the catheter itself. It's strong and I don't know if we had a manufacturing defect, I don't know what happened, but this guy, when he tried to pull it out, that long piece, which is about six centimeters, well it is six centimeters long, was still in the patient and everything else came out. And it's a freak out moment because it's floating in there and that could ultimately migrate to your heart is what can happen or create a clot if it goes to your heart. And so there's, as everybody is sort of freaking out in this lab, I mean, you start looking for equipment, you start looking for different equipment they have on the shelf that's not your equipment have to be a different company, but you've got to kind of know how they work to be able to fish this out, which we ultimately were able to do. But yet you had to really be, I mean, you know, as the doctor's throwing my equipment on the floor and dropping a lot of f bombs, you've got to keep your cool. You can't be freaking out like going, okay, I'm never going to work with this guy again, he's never going to call me again. You've got to go, okay, we've got to get this thing out of there. Right. And so we did and it only took us like another 10 minutes and then everybody kind of laughed afterwards. And you send the device in, and I don't know what happened, but I still was able to do cases with this guy.
Pat: What advice would you give somebody that thinks medical device sales is where he or she wants to be?
Matt: You know, depending on the stage of your life, I would tell people it's a good field. You know, the frustrations, medical device reps are infamous for having cups of coffee or beers together even as competitors and griping about how tough it's gotten, especially those of us who have been in it for a long time. But it's a good space. I mean you're dealing with highly educated people. I still think it's really cool to go in these procedures and deal with putting scrubs on and going in there. And I think it's fun. I really, really enjoy it. I enjoy the kind of the locker room banter that happens with these cath labs and some of the funniest off-color jokes I've ever heard have happened in these cath labs. And they really are a family. And so when you are kind of accepted into that family, it's really cool because they don't just let anybody in. But what I would say is while it's compensated really, really well, you have got to be kind of patient with yourself because you're not going to come in and immediately start making this big money you hear everybody makes and you've got to be willing to grind it out and do things that like as you're interviewing for the job or as you're making this decision to get into device sales, that you don't even foresee. I mean, it sometimes is bringing in 60 Chik-fil-A sandwiches that he had to order the night before pickup at 5:30 in the morning in Lafayette, Indiana to bring into a 6:00 AM inservice just to get...
Pat: Sounds like a real world example.
Matt: Yeah, I've done it a lot, just to get in front of a doctor at 6:30 or 7:00 because that lab manager will now let you in. In my world, it's very common to have my competitive rep standing right next to me in a case and trying to sell your product in a professional way. Number one, not giving away your trade secrets, and number two, not getting in an argument over the patient, sort of in a professional clinical setting. And so I would tell people they really need to figure out how competitive are they, really? How hard are they willing to work? You're going to get humbled a lot more in this job. Let's put it this way, this job is more baseball or golf than it is any basketball or football, right? You're going to fail more times than you succeed, but if you are successful three or four out of every 10 times, you're more successful than most people. And you have to just be able to take that and still be able not to show those emotions sometimes in those cases when things don't go your way.
Q: What do you think you'd be doing if you weren't doing this?
Matt: You know, I probably would have gone to law school. I mean that was what I was gearing up to do and I just didn't, I took the LSAT and I just did okay on it and not enough to really go. I really wanted to go to University of Missouri Law School, that's a good law school, but not good enough to get in there. But I could have taken it again. And at that point I just said, you know, I'm going to go work for, my plan was to work for a couple of years and then go to law school and, and just really never looked back. But I probably would have been a lawyer.
Q: How can people find out more information about your company, where can they go to see what you guys do?
Matt: Yes, www.medtronic.com, it's got all of our divisions on it. If you Google search Medtronic peripheral vascular, there'll be all sorts of things that pop up. It's really cool now because you can hit videos or pictures and it will show all of these things work. That would be the most comprehensive way to find out about it.
Q: Anything else? Anything you can think of? Anything I haven't asked you that you think would be important for somebody that's either trying to get into this space or that's already in the space, but they're trying to move up the proverbial food chain that you could think you'd like to share with them?
Matt: You know, if I was already in the space and let's sayI was wanting to get, and I wish I would've done this by the way, back when I was new in devices, you'll walk down the hallway and go into cath lab or go, you know, get to a hospital really early and go back there and say, Hey, I'm working in GI or I'm in general surgery and I'm thinking about getting in this space, who's your lab manager? And find out who that is and just ask the person to buy him or her a cup of coffee. It may not go anywhere, but at least you can kind of get a feel for what that's like. And then other than that, I would really go to great lengths to network, even with your competition. I used to do that a lot better than I do now. The older I get, the more I'm sort of like, you know, they just tick me off and I don't want to talk. Networking is a good way to do things. And then just making sure you have a stellar reputation within these hospitals so that as you go through the interview process and somebody is going to vet you, because we all do it, that they've got really good things to say about you.
Pat: Great advice. I like that, especially the stopping into an area that you're thinking about getting into and just seeing if you can buy the manager a cup of coffee. That's a great idea. Well, we are just shy of an hour here so I wanted to thank you for taking the time to share your experience with us.
Matt: Absolutely. Well, thanks for putting me on the podcast.
Pat: Yeah, no, thank you. Maybe we'll have you back and we'll approach it from the manager's standpoint since you did that for quite some time too.
Matt: Okay, great. All right.
Pat: Thanks Matt, appreciate it.