Show Notes: All items in bold are questions I asked, or thoughts I have inserted post podcast.
Episode 3 - Jeff George
00:00:00 - 00:05:02
Hello and welcome to the podcast for inside med device sales. My name is Pat, I am your host and it is my responsibility to introduce you to some people that can help you get to where you want to go. We are going to meet current medical device reps and learn how they got started. What the process was like for them what their day to day activity is like and what some of their biggest challenges are. We'll also hear about some interesting cases that did not go as planned. We will also speak with hiring managers where I will get to ask how they select candidates, what they look for, and how candidates can stand out over the competition? I will also introduce you to medical device recruiters. We will learn about the role they play in the process, different ways to highlight your strengths as a candidate, and the things all candidates should stop doing. Lastly, we're going to be speaking with the physicians that look to their reps for support. We will hear what it is they appreciate about their reps and the thing great reps do to add value to cases. So thanks for being here, let's get started.
Hello, and welcome to another podcast episode for InsideMedDeviceSales. Today, I have the distinct privilege of introducing you to Jeff George. Jeff got his medical device sales career started back in 1992 when he worked for a company called Valley Lab, which I believe was later acquired by Covidian. Following that, he moved to Intuitive Surgical, which is the leader in robotic assisted surgery, which is another very technical sale. Following that Jeff moved to Medtronic in 2004 in the Cardiac Rhythm Management division, where he has been for the last fifteen years selling pacemakers, defibrillators, and heart failure devices. Jeff is going to provide some great insight on to things that he does to distinguish himself from his competitors, and things he does to add value to his physicians and the staff that he works with. He's also going to shed some light onto the lifestyle that is medical device sales, particularly if you are in a role where you take call. I hope you enjoy this conversation as much as I did. Without further ado, ladies and gentlemen, Jeff, George.
Pat: Jeff, welcome to the podcast, thanks for being here.
Pat: I'm actually thrilled that you're here. The reason for that is a couple things. One, you've got some fantastic experience, which I'm sure some people are going to benefit from that experience. But from a medical device sales standpoint, and I'm sure there's some people out there that would argue about this, but I would say you and your role, what you do, you're at the top of the food chain. And there are some different reasons for that and we'll get into that in a little bit. But from an engagement standpoint, from a responsibility standpoint, I would say your role is about at the pinnacle of medical device sales. So thanks for being here.
Jeff: Thank you.
Q: Can you share with us how you actually got into sales, not necessarily medical device sales, but just your first sales job. How did that happen?
Jeff: That’s going to be an interesting one. My father bought a moving company when I was nine years old, and I grew up in the moving business working in the warehouse and he'd take me on the weekends and I would wash trucks and stuff like that. And as I got in to college, my dad was looking for a way to keep costs down. And he said, hey, I’ll have you be a sales guy, but I won't put the pressure on you to be a real sales guy. These are already sold orders, you just need to go to the customers. We had these big national accounts, so I was kind of like the service guy. So I would go to this national account, kind of like Medtronic moving you or I. I would go in and do the estimate and interface with those people and I'd bring that back. So I was only doing national count presold type experience. But from that, I got a lot of customer interaction. And then as I started that I think gosh, probably my Freshman summer of college so going into my sophomore year. And then they decided, hey, you're not bad at that.
00:05:02 - 00:10:08
We're getting good feedback, would you like to try to sell local moves? And local moves were terrible to sell because most people, if they're moving locally, are going with the cheapest mover, right, lowest price per hour kind of thing for two men or three men and a truck. And we had very high local prices. We weren't the big player in that, but that was by design. And so I had a terrible closing ratio, yet you're going out there, and you're twenty dollars, thirty dollars an hour or more for your crews, sometimes fifty. I didn't close anything. I remember my closing ratio was something like 15%. And I would go back and tell my dad, you know, we’re just too expensive. And he would say, I don’t want to play in that game. So I kind of did that as an experiment, but I got a lot of sales experience in that and also got a lot of rejection in that, I can tell you that. That summer was a bad summer. I just didn't feel good, you know?
Pat: A 15% closing rate, that means 85% of the time you're hearing, no.
Jeff: You're driving all over the city of Pittsburgh, all these neighborhoods. You're getting tickets in every little community speed trap. You call your boss constantly, and back then, keep in mind this is 1987, and that’s when we had paper maps, and you went to a payphone, and there will be a line at the drive up payphone of sales guys waiting to make their phone calls. So my first experience in sales was like the school of hard knocks. It was a terrible experience. And then the next summer I said, hey, I want to be a real sales guy, give me real long distance moves to sell, real appointments like the other guys. And then I started, I was a pretty competitive person, kind of like yourself, and I said, if I'm going to beat these guys, I better buy some books and stuff. So I bought all the latest things, back then it was Brian Tracy, Zig Ziglar, Tony Robbins. I was listening to the neuro linguistic programming tapes. Every time I was in my car, I have one of those cassettes on. The first post on this blog is about how it all started for me. I remember listening to types like this as I drove all day, knocking on doors, trying to get a chance to demo my copier. Another copier rep rode with me one day and we listened to these tapes. When we got to our prospect’s office, the other rep started using terminology he just heard on the tapes in my car. He referred to something as “improved” because no one wants to try something “new”. I made a comment to him after the call and he said, “See, I was listening.”
Pat: That’s awesome.
Jeff: Right? And you're listening to a guy talk to you about how to respond to objection, right? The old feel, felt found. And I kind of got into body language tapes. And then I got into listening to tapes on how to communicate with people and understanding if they’re auditory, visual, or kinesthetic and using auditory, visual, kinesthetic phrases with them. How to build rapport quickly because you're in the home, you're out of the home, you got a quick impression. If your price was on the money then the guy they liked they went with in that business. So that next year I did pretty well. And I came back my senior year of college and did the same thing. I actually did work for them while I was in college. So that's how I got into sales basically. And came out of college, then I took over the sales and marketing department for the company about a year out of school. And that's kind of where it all started though, in the moving and storage business, a very unlikely place.
Q: What are one or two key learnings that you took with you from that job?
Jeff: It was quite humbling, and it was hard work. You know, moving and storage guys, the moving business, guys didn't make a lot of money. I picked up a really good work ethic out of that. I think it really taught me the fundamentals well and it also taught me a lot about rejection.
Pat: Right, like how to not take it personally?
Jeff: No. When you have to relocate somebody and it's $20,000, they’re going, it's expensive, and they wanted to know why you were more expensive, and then you had to sell why you were more expensive than them. But I think the key takeaway was just sales wasn't easy. I can remember sitting there, and I laugh about this now, I would be soaked in sweat underneath. I mean I would be so nervous sitting with a customer when I was young. But I think that prepared me for when I was selling for Intuitive(Intuitive Surgical), standing in front of the hospital board, doing a presentation. So it just taught me a lot of the fundamentals early.
Q: What made you decide to start looking at other opportunities?
Jeff: Well, one, the moving and storage businesses is full of families. I had hired a consultant to come in, we were going to start a new product line. We were going to start moving companies, which was more lucrative and kept the trucks rolling. It’s a heavy asset based business and kind of like airplanes, you want them in the air all the time, you don’t want them on the ground.
00:10:09 - 00:15:05
And so we were looking at ways to get into a market only a couple big players in Pittsburgh were doing and it was quite lucrative. There wasn't a lot of competition that was capable. So I hired this guy who was considered one of the national experts in it and he had a consulting package. I brought him to Pittsburgh and after spending three days with the guy he handed a book to me called The Seven Habits of Highly Effective People by Stephen Covey. And he said, you know, this industry is not as sophisticated as you are. He was very complementary. He says, I think you need to read this book, and you need to leave. I’m like, what? He said, you're never going to rise to the level of your potential working in your family's business, working for your father. I see that interaction. And it's something I already kind of knew, you always had those thoughts in the back of your mind. My dad was a math teacher by training, got into sales because he had three kids to feed living in Chicagoland in the sixties and seventies with no money, and he saw the sales guys made money and he ended up becoming a general manager of a moving and storage company. And he saw the owner was absent so he wanted a piece of the business. They wouldn't give it to him and he went out with $10,000 and bought a bankrupt company with the help of the old Vanline. And voila, my dad became an owner. But that's a little off topic.
Pat: But a great story.
Jeff: With that comes, when you're working in a family business, those dynamics for anyone that is listening, those dynamics are very difficult. And I started becoming distant from my family. My brother was director of operations, and he'd gone at work at a very large multi-chain Vanline down in Atlanta. They had like nine location, so he had good operations experience, but there were things where he was quite rough on at the time. And I felt like my impact was not being recognized. I worked with some of the largest international moving brokers, and that was a very lucrative space for us, margin wise, and I went out and found all the top bookers in the country and they taught me. I flew there to them and found the top bookers. How do you write an international, or how do you sell it, you know what I mean? So we took that and blew that business up, and I won International President’s Club. At twenty four years old we won two trips, an overseas destination. But that was basically, not reinventing the wheel, but finding the best people at it and then going out and getting it. But all this is going on, I'm trying to start up this other product, which you know, we're trying to redirect the company a little bit. We’re in low margin market segments and we're trying to push ourselves into higher margin market segments. And it was that guy, I can't remember his name right now, he's out of Atlanta and he hands me this book. He goes, you need to read this book. I read the book and I read it again. And then I went to my father and said, you know, I think I gotta leave and I'm going to give you a one year notice. So it's January so in December of this year, I will exit. It’s kind of interesting. So that is how I started looking., through The Seven Habits of Highly Effective People, which is still a bestseller today after all these years. I realized my strength was always science, and I didn’t like sitting behind a desk. I like sales, I like good customer interaction and science was kind of my thing that I was 99th percentile testing out when we were kids growing up. With that, I decided that I would go into a medical area based on what my personal strengths were and what I liked. I was always keen in those things.
Q: So you decided you're going to look at medical. How did you go about trying to identify opportunities? Were you networking, were you talking to recruiters? What did that look like?
Jeff: I did a little bit of both. There was a networking club in Pittsburgh that I had joined with some guys I went to IUP (Indiana University of Pennsylvania) with, so I was with those guys. I met with a couple recruiters, a couple of them gave me the cold shoulder because they thought I was daddy's boy with a silver spoon in my mouth. And then a couple said, hey, you know what, you might be good. And I met one in particular. She said, you know, you'd be perfect for this job that we've got coming up. I think your kind of personality and these things would gel well in this one medical company. I'm going to see if I can put up. It's an expansion role, so there isn't a lot of risk for them. They're looking for someone like yourself. So the one recruiter. she hooked me up with interviews at Valley Lab. Ironically, a couple of companies, medical companies, they interviewed me but they said I'm a risk.
00:15:05 - 00:20:01
I’m from the outside, right, so I’m a risk.
Pat: No experience.
Jeff: Right, no experience, you’re a risk. But I had a great sales track record within the Vanline business, right. You know what I mean, to some degree, selling is selling. But also being able to be malleable and being able to learn new things, as you know, is quite critical in this role. I said, look, I got high learning agility here, I can do this. And they said, no. And ironically, I did have offers to go sell copiers, and I did have job offer to go to Liberty Mutual or John Hancock, one of the financial firms. So I did have opportunities to stay within the moving and storage business, which I didn't take seriously. I was leaving that industry altogether. And so the one recruiter, she got me into the interviews at Valley Lab and I ended up landing that job in Pittsburgh back in ‘92.
Q: So when you were going through the interview process with Valley Lab, can you talk about what that was like compared to any other interview that you've had? Just being in medical sales, but did it feel different? Was it different?
Jeff: I was interviewing around at the time, so inside medical and outside medical. It's kind of interesting, I hit it off with the HR director and the hiring manager within like the first five minutes. You know, things just seemed the flow. Other interviews, people looked at me. My family's business was known in the city, and so I kind of had the stigma following me around that I was the owner’s son. You know what I mean? And that maybe perhaps being that I was the owner’s son, I didn't have the skill set, or maybe I was in my role for the wrong reasons because of nepotism, right? So in that interview, they kind of wanted to see, it was a different philosophy. They wanted to see what I was made of. What's interesting is back then there was no internet. Well, there was, but remember it was dial-up, so I had to go down to Carnegie Mellon library and research who Valley Lab was, this medical company is only a hundred million dollars out of Boulder, Colorado and I couldn’t find anything. You know what I mean, how do you search? And so I had created this whole folder from the Carnegie Mellon library, so talk about doing research. You know, you had to go to the library and get on a computer, one of those terminals, and search periodicals. And I had printed all that stuff out and I'd formulated a bunch of questions about the company because I really didn't know anything about that. And I had to figure out who are these people and what do they do? But that interview, being that they weren't from Pittsburgh, that stigma didn't follow me of being the owner’s son. I think they saw it as, here's a guy who knows that moving and storage is not his thing, records management, distribution, etc. I wanted to break out on my own and do my own thing. And they gave me the benefit of the doubt, it was just a completely different interview. You know, the irony of that interview was I was so nervous I stopped in the restroom ahead of time. Go check your hair and your face and no food, check your tie and all that. And you go through the interview. Well I left the interview and I left my notes behind, like the entire manila folder, everything I printed off the web at the time from Carnegie library. And not only that, I went back to the bathroom and realize that I didn't take care of business and my fly had been down during the entire interview. That later became a really funny joke when I got the job. They said anybody that was bold enough to leave his notes behind and go through the entire interview with his fly down, we had to hire you.
Pat: That is hilarious.
Jeff: It was literally like right out of a Seinfeld. I went back to the bathroom, I went to put my fly down, and I'm like oh good God. So to this day, that manager now is at another medical company and still a good friend and he tells the story every once in a while to people that I came in there and I was so bold that I didn’t have to keep my fly up.
Q: That is funny. So for those that don't know, can you tell us what Valley Lab does? What products did you sell?
Jeff: At the time Valley Lab was the world leader in electrosurgery and ultra-sonics. Ultra-sonics was a device at that time was called the CUSA, cavitation ultra-sonic surgical aspirator, that originally the technology was made it became the facal emulsifier, it was used in the eye and they had taken it and adapted it to be used to debulk brain tumors. And later, you know, give a surgeon a tool and they look at the tool and go, you know, we can do this with it, right? So then it became adapted to resect the liver parenchyma for liver cancer, cytoreductive surgery in ovarian cancer.
00:20:01 - 00:25:03
So I would be in all those kinds of cases. And then electrosurgery is used in about every kind of surgery where you cut the skin, as you're well aware. So we had sold some laparoscopic electrosurgical instruments, that was the early lap chole days. So I was selling into lap chole and some of those things, but as you know, electrosurgery, also known as the Bovey named after the inventor William T., pretty well used product, it’s in every operating room and outpatient surgery center you can think of. So it got me a lot of exposure to a lot of different types of procedures. And I spent a lot of time in neuro debulking brain tumors. CUSA's were an $80,000 - $100,000 capital sale per unit, so if someone called you for an evaluation on a machine you went.
Q: Absolutely. So did you find out that when you were doing that job, did you gravitate towards one of those specialties?
Jeff: I would say no. At first, I was completely overwhelmed. There's another sales guy that used to sell to Valley Lab is how he was discovered. They really liked him and offered him a job and he and I were in these expansion territories. And he was a Colorado boy, his name was Chip, great guy. And we're in the Residents Inn and, you know, medical you can't understand a paper. You have to have a certain vocabulary, an understanding, right. So we're sitting there, and we had this procedure we were trying to learn, it was called large loop excision of the transformation zone. Fundamentally what it was, women had developed cervical cancer, we had a loop electrode that you would plug into the generator. We had an optimized mode that cut off the end of the cervix, and you would teach this technique, and you had to know cold. So we're reading this paper and it’s a published journal article from one of the GYN journals, right? And we can't understand anything. We're looking up the words. We've got Taber's Cyclopedic Medical Dictionary. Remember Taber's?
Pat: Oh yeah.
And we're looking up words, and then we've got this cheat sheet of prefix roots and suffixes. We're reading okay, it's ectomy, so is that excision of, you know what I mean? It's otomy, that means to cut into, and we're going through this. And after like the second night, Chip says, dude, I need a break. He comes back with a six pack, and he just takes one, opens one for me, opens one for him. And you know, we're living in this Residents Inn for a month. And he goes, dude, you know, we are totally over our heads. They’re going to drum us right out of here. We can't understand a thing. We're screwed. And he goes, dude, you were selling moving and storage. You can tell me how to ship something to China. I can tell you how these chips work, and we don't understand anything we were reading. So that was a very stressful, humbling time, so got kind of thrown right into it. And so specialty wise, I would say we did a lot of everything, but I would say no. But it was just, we did everything from urology, from trans urethral resections of the prostate, cholecystectomies to oophorectomies and hysterectomies, bowel surgery, but I spent a lot of time in general surgery. So from I think an experience standpoint, that actually helped me in my next job when I went to Intuitive that they had seen my background was so extensive in the energy based systems and all the surgeries I had done. It was like a natural fit to go into robotic surgery. It kind of set me up for the next job.
Q: Can you can talk about that a little bit? So you left Valley Lab and you went to Intuitive Surgical. Again, for those that don't know, what does Intuitive Surgical do?
Jeff: Intuitive Surgical was a spin-off of a DARPA project by Fred Mole. He was out of Stanford, so they were looking at how do they protect a high value asset like a surgeon, yet bring the state of the art surgery to a battlefield situation. And so they had mounted these robotic arms inside an armored personnel carrier that had been converted into an OR. And you'd have these OR techs that would position the robotic arms on the patient. So it was kind of like a proof of concept that came out of DARPA, and Fred Mole and some of his investors. Fred Mole was already independently wealthy, he had founded a couple of other companies. He had developed some key things, like the trocar. He had some key patents. He sold that to US Surgical. So he came in and took it and licensed the technology. Intuitive went public in 1999, but they licensed and built the Davinci surgical system and there are now multiple versions of that.
00:25:03 - 00:30:03
But I was there on the ground floor, robot #24 had been sold to the Cleveland Clinic when I was hired. So I came in quite early.
Q: And so was that, again, where you in multiple specialties for that that type of procedure?
Jeff: Yeah, at that time, the only approval we really had was lap chole. We didn't have the approval for anything else. But kind of the way I landed there was when Valley Lab sold, we were one line on the annual report of Pfizer. Pfizer had a medical device group about a billion dollars in four companies. They spun us off, and we got sold to US Surgical, who nine months later sold themselves to Tyco, and at that point in my career I was Presidents Club three times, regional rep of the year three of four years. I probably should have left Valley Lab after six years, I stayed for eight because of the relationships I had with some of the senior executives. Ironically, the executive team that came from US Surgical to do the absorption and integration of Valley Lab into US Surgical, is the team that recruited me. When they left, they both went to Intuitive. So those two sales executives, business executives, went to Intuitive and I got recruited by them to go over there.
Q: And then from Intuitive, is that when you went to your current role?
Jeff: Yes, after about three years on the button.
Q: And can you talk about your current role? What is it exactly that you do?
Jeff: Yeah, right now I am the Principal Sales Rep for a territory in the Cardiac Rhythm and Heart Failure space at Medtronic. That involves pacemakers, heart failure devices, injectable cardiac monitors. I currently run a pretty good sized business and have four clinical specialists that work for me. That role entails everything from doing an implant, programming the patient up, and setting up their home monitor, to meeting with the hospital administrators, purchasing department, ect. So it’s a pretty, it's not only a clinical but it's very business oriented, as you know, that's your background. So you're the Jack of a lot of trades in this job.
Q: And that's, I think, one of the reasons I mentioned that this role in particular, and again, I'm sure there's some people that would argue with me about this, but I think this has to be one of the roles that's highest on the food chain in the world of medical device sales. And one of the reasons is just what you said: the responsibilities that you have, not only in the procedure, but outside the procedure. You have to be a clinical expert in a lot of different things, all of which involve arrhythmias, which are not simple to understand. But yet you also have to be an expert in business and contracting, negotiating, and you have to be able to speak with a CFO and then fifteen minutes later, you're talking to a board- certified Electrophysiologist. So can you talk a little bit about how do you deal with that? How do you communicate with both the clinical side and then the administrative side. What's that look like?
Jeff: Yeah, I'll back up one second. I agree with you. It's the hardest thing I've ever had the learn, period. I tell people…
Q: The arrhythmia side?
Jeff: Electrophysiology is an animal, it is a beast to learn. Ironically, though, learning it makes you better at your job. So I just had my fiscal year end quarter end, and there is probably a good segue there. The better you get at detailing the value proposition to an administrator, because the first thing they're saying is, you know, you've experienced this, you know, we're spending four million dollars a year with you. We’re spending a lot of money. Physician preference product, right? And why should we not direct them to a competitor? So you gotta get in there. And so really knowing how to relate the clinical benefits of your technology to the non-educated buyer takes a lot of education on your part. To a large degree, a lot of my customers that are non-clinical have been with me the longest. I spent a lot of time giving them clinical papers and giving them high level overviews about why our technology or offering, our value proposition, is superior to our competitors. So I would say there's a huge consultative sales approach there. I've always had the philosophy, this is going to be a customer for life. I've got a guy that cut me a large order at the end of this quarter.
00:30:03 - 00:35:00
I've been calling on him since 1993, since he was a buyer, and through multiple jobs. So there's a total lack, I won’t say lack, but there's such trust between he and I. But there's been years of, I think you just got to provide your customers with a lot of material in a manner they can understand that provides value to them. And that if they lead, you know, it’s classic, how many guys have gone to committee, and I'm sure you've heard the stories, and then as soon as the rep walks out of the room, and they say the rep said that doctor A would do this, you know, this and that and this and that and when they asked Dr A, there's no support, right? There's no support for what the rep just said. And I think what we're doing, it's just the opposite. And I think working for the leader, it's a plus and a minus because the competitors are always right on your backside. So I would say, just very, very heavy… I try to educate the people that aren't clinical buyers but they have got the ability to write the check and cut that big PO. I try to make them feel as comfortable and as important as, you know, they're critical. It’s critical to have those people, they want to play in your court, right? They want to be in your game. And they don't always want to be, as you know, depending on what physician preferences and influences currently exist in the hospital. So it's a very soft sell on that side and, you know, it’s very business oriented as well. On the physician side, it's a very technical sale. And it's highly clinical. It's reading the entire history and physical and then discussing what we're going to do in this procedure. So I think that's what makes this thing quite the animal.
Q: Is there anything that surprised you about this? I mean, I don't know how much you knew about this role when you got started, but is there anything that once you got into it, and you were like, holy cow, I can’t believe I’m doing this?
Jeff: Absolutely. I was overwhelmed. I had an opportunity to interview with Medtronic to go into a surgical valve job. They were calling me, and I didn't disclose that I already had an offer in CRM. So I knew the valve, the other rep, well from my previous roles, we were always bumping in to each other. And I remember all the, and you and I started about the same time, you remember they used to send you Ellenbogen’s book, remember the big, the bible, the EP bible? This is this a physician's textbook. Remember?
Jeff: And that big blue thing shows up, the rhythm book shows up, and Dubin’s book shows up and all this. I'm opening this stuff up and I am like, what have I done? This is engineering, you know, I mean, I love science and all, but man, I love chemistry, I don't love engineering. And I was blown away. And I don't know how you felt when that stuff showed up and you started trying to read it, but I kind of had that trip back to the Residents Inn Boulder, Colorado with Chip sitting there cracking open a beer going, you know, dude, we’re doomed. I looked at my wife and I said read this, just try to read it. She's like, oh my God. How are you going to sell that? I don't even know how I’m going to sell this yet. And you know, it's the law of forced efficiency, the law of forced learning. It’s learn or die, right? And if you recall, remember they used to send people down to ATI for training?
Jeff: Since I was so new, they were like, hey, we're going to send you to ATI first week on the job. Honest to God, I started on a Monday and on the next Sunday, I was on a flight to Charlotte to go to Greensborough and go to ATI. And you know, I'm so blown away by all this material, technical material that showed up at my house, I stuck the pacemaker encyclopedia in my back pocket. Remember that little reference guide we had for all the terms?
Jeff: And so I'm reading the pacemaker glossary/encyclopedia on the plane and I'm just like, oh my God. So that was I would say the part that I take for granted now. But then I was, and I knew if I resisted I would die, I wouldn’t make it in the job. But I will tell you, it was a brow beating. It was the technical rabbit hole, I call it. And you and I both know, the better you are technically, see I was a very sound salesman. I had been selling capital a long-time. I understood how to talk to people, I understood how to present to
00:35:01 - 00:40:03
the C-Suite, I understood. I never had to talk to a surgeon at this level, this level of technicality. You know, here's the valve. Here's how it goes in. Right. You know what I mean. The stuff I was doing before, you're peeling off a gallbladder from the other side of liver, not crazy technical, right? To now, they got this programmable computer, you need to understand what drugs they’re on, you need to understand all 26 heart rhythms. You need to be able to look at something and know what it is. It was the application of a deep rabbit hole of knowledge. I never quite had a job like that before. Teaching electrosurgery was not that difficult, Ohm's law. That was easy to learn and understanding how a generator worked, it delivered energy and all that. That was child's play. And so really that hurt. I was really stressed out. Back then, I think as you know, you are expected to go through training and be proficient within a year. I went through all training and sign offs within nine months, and I was pleading for more time. Now today, HR will give you a year and a half to two years. When I went through, it’s like do or die.
Q: Do you remember your first solo case?
Jeff: I was terrified, I do, and they were rotten. I had this physician who was a real practical joker and unbeknownst to me, you remember the demo Adapta pacers?
Pat: Oh yeah.
Jeff: So they had a demo Adapta pacer sitting at the top of the bed with the anesthesiologist. So we're doing the case, my reps out in the hall, he's looking at me and I'm programming away. Or not programming, but I'm doing the analyzer.
I pass off the device that you peel open for them, and they do the other peel pack and they turn and basically, I guess someone on que rolled that demo pacer across the floor back at me. And you know, my heart just sinks to my stomach because we just dropped a $7,000 device on the floor. And that's, you know, what am I going to do? And they all just saw my eyes get real big. I bend down like, oh my God. What am I going to do? Am I going to have to get special credit?
Pat: That’s awesome.
Jeff: And I go and I'd pick it up and it's clearly a demo can. And I turn around and go, you guys are just rotten. The guy hooked the leads up to the analyzer backwards on purpose. He put the atrium on the ventricular channel and the ventricular lead on the atrial channel. They were doing everything to try to throw me off.
Q: So for people that don't know, can you explain what the analyzer is? You mentioned it a couple times.
Jeff: Yeah. The analyzer is a piece of the programmer. It's a separate module but you pull it up through the programmer, and through that we look at the electricals of the lead. We can sense atrial beats and ventricular beats. Basically, it's a way verifying, just like if you're an electrician, that we've got good electricals coming through that outlet in the wall, that we've got good ground, that we've got everything connected properly. We've got good, sound numbers that will activate the heart in a way that the device is going to last long is going to appropriately sense, pace, and so you really can't do an implant, as you know, without an analyzer.
Pat: Which again, that's another reason that this position, in my mind, is so high on the food chain. You have in-depth involvement in every procedure. At some point in every one of your procedures, everybody in the room is looking at you, and you have to provide some answers, and that doesn't happen in many other sales, device positions.
Jeff: I would agree. When I went through training I got in an argument with one of the lawyers that came to training. If you remember, you and I went through together, they had a lawyer. I think we were in a class together.
Jeff: And the guy tells us, don't read the history and physical of the patient. I’m like, how can you even be an effective resource if you don't understand what you're dealing with.
Pat: I remember that.
Jeff: I got into an argument with that guy. I said, you know, every physician sits down with me, and if they don't review it with me, it's because they expect I already reviewed it. That was their expectation. And you know I'm just not going to win this argument with the legal guys at the corporate office, right?
Pat: Probably not.
Jeff: I just don't know that that guy truly understood our role and what my role was. Because, like you said, you had to know if that patient had any escape rhythm with their complete heart block, right? You had to know if you paced a certain way, would that be a risk? Do they have bad plumbing?
00:40:04 - 00:45:06
Do they have aortic stenosis? Do they have a lot of TR, tricuspid regurge? The things you needed to know. Have they been on steroids? What lead are you going to pass off? Maybe you want a passive lead so they don't perf because the hearts altered from the steroid use over that chronic stuff. See? So I just made it a point to really read H&P, and I found that actually enabled me to build credibility with the clinicians, with the physicians. If I ask them to review their plan of caring for the patient with me and go through the H&P… Now it annoyed a couple of guys, looking like, hey, shut up rookie, right. You always have guys that want to teach, and they saw that you really wanted to learn this thing, right? And then you would ask, hey, why are we doing what we're doing? Why would you do it that way? And that became, I think, when you approach it humbly that you don't know squat. And I've told people now in this business, there's levels of confidence. And you might have heard this before, but you come into this job and you're unconsciously incompetent, you don't know what you don't know. And then you go to ATI or you get all the material that shows up at your house. You’re like, good God, I am consciously incompetent, completely, completely incompetent. And then you go through all the training, and you go, okay, you know what I'm kind of becoming competent here, kind of consciously competent. I might be incompetent in some areas, but I kind of know what I’m doing. I can look at a rhythm, I know what it is, I can pace, I can sense. I know what the good numbers, the slew, should be. I know what the leads are made out of. I know this one's titanium nitride, this one is nickel. And I know what the steroid is on this lead. And I know what the helix is on that lead and how it extends and what it looks like under fluoro, and now you kind of know your thing. And then at some point you kind of become unconsciously competent where when new products roll out, everything's built on all of your past knowledge, as you know. As we keep rolling out new products, everything you learned in the past that just keeps building up and enables you to learn more.
Pat: It's a great point.
Jeff: It is horrifying to be consciously incompetent, you know what I mean in?
Pat: Oh yeah.
Jeff: But I found that approach with the physicians, they appreciated that I didn't walk in acting like I knew what I was doing because, as you know, nobody trusted you. Nobody trusted you. It took a while to build trust with people. I mean, some people took years, a year or two years.
Pat: And some of those people, they will do things intentionally to see how you respond. Do you admit that you don't know, or do you try to make something up? They obviously know the answer, so they know if you know, and they know if you are making something up. And again, they're doing it to decide, can I trust you?
Q: What do you think is the most challenging part of your job?
Jeff: The time commitment. It's a lifestyle.
Q: Can you talk about that a little bit?
Jeff: Yeah, it's a massive time commitment because if you're not in a case, you get called to go check somebody in the ER, check somebody in the nursing home. I’m on call twenty nights a month and I rotate every five weekends. And I think that demand, we have a remote technical service so I’ll get remote transmissions in the middle of the night to review and then callback. So I think, it's never, the job does not shut off, if that makes any sense. You don't go home like a lot of people. You don't leave your office at the bank and switch it off. It doesn't get shut off. Physicians text me, hey, I'm adding this guy in the morning, be prepared and bring this or bring that. You know, bring x or bring y. So that part for me, I'm fifteen years in this now, starting in October it will be fifteen years, I have been, when I'm not on call, I don't answer my phone. I've tried to really adapt to that, but it's a lifestyle. I mean, that you're always on, and you're always available and that's the part with any other sales role. Even taking vacation, I had hip surgery two years ago, and I had to take eight weeks off. Sales plummeted. It was my worst quarter in thirteen quarters. I had people freaking out, and I kind of loved it. Because you know, I think there's people that don't do what we do within our organization that think that it's because we have the best product on the planet that it just sells itself.
00:45:06 - 00:50:01
We just need average reps. I think that my hip surgery proved that good reps sells a lot of product, a good rep isn't around, and you got a bunch of splitters, it's out of sight, out of mind to some degree, and my sales plummeted. You're not in their face, you're not present, your skills aren't on exhibit with them, you're not rounding with them and consulting with them, then the business drops. So that eight weeks of being off was a real eye opener I think to the guy that was managing me. The next quarter back, I blew it out. But it's a lifestyle, and it's a sales job that's intrusive in every way. Taking two cars when you're on call.
Pat: To your kids’ events or something.
Jeff: Yeah, to everything. I've been in Pennsylvania and I live in Ohio two hours away with two cars for a holiday. I work the day after every Thanksgiving. It's a big implant day. I've implanted right up till seven o'clock Christmas Eve. So that's what's different about this role versus a capital role, the Valley Lab role, or the Intuitive role. There's nobody standing there still doing stuff, you know?
Q: You talked about sales going down when you were out, or going back up when you come back. Can you talk, and you don't have to give trade secrets here, but how do you differentiate yourself? Obviously, you've got some competitors in your space. How do you differentiate yourself from your competitors?
Jeff: I gotta give my props to my competitors, they are all very competent reps. They all know their stuff. I try to take it, even the customers that don't use me much, I just try to be a genuine person with them. You know, I like to say I’m a closer. I always close quarters strong. But none of my clinical customers feel that pressure, if that makes sense.
Pat: It does.
Jeff: I’m a highly consultative, not exquisitely technical but highly technical, sales rep. There's people that are far more technical than I, but they don't have, typically, the sales experience that I have. So I'm kind of a soft, technical but persistent guy. And once you understand a physician's preferences, when there something that you have that there's good data on, then when you're in an implant or it's time for that algorithm or that part of the device to shine, that's where you're selling.
Q: Can you talk about some things that you do during cases, or maybe even outside cases, but things that you do to add value to your customers?
Jeff: I read the history physical ahead of time. I try to get as much information as I can so that will help the staff with even how they're going to set the room up. Is it right sided, is it left sided, which sheaths to pull.
Pat: Good point.
Jeff: What equipment we're going to need in the room. So in most of the hospitals I work in, I would say these people think I work there. I just try to integrate myself right into the lab like I’m one of them. And so I’ve worked in the lab long enough now, you know what people, you anticipate what they would do. I’ve helped move patients off the bed, when you get questionable labs or things like that I'm tracking down the doc on their behalf. Say look, we got questionable labs here. Here's the creatinine and here's the hemoglobin, here's the INR. Do we really want to be poking somebody with an INR of three, stuff like that. So I've over time learned that these people appreciate another knowledgeable person in the room that thinks like them, if that makes any sense.
Pat: That’s a great point.
Q: How do you think your role has changed over the last five or ten years, or has it? And by your role, I don’t mean your role as the device rep, but just in medical device sales. Do you find that you're doing things differently today than you did five or ten years ago?
Jeff: Oh absolutely.
00:50:01 - 00:55:06
I mean, one is I'm just getting squeezed. My productivity is ridiculous, relative to the number of people. With all the job cuts and aggressive price reductions that have occurred in this, we eliminate staff to maintain profitability. I'm as busy as I've ever been, inside and outside of the hospital. I tell people that basically as we have been flattening the organization, I feel like I have turned into a customer service, technical service, I’ve become the everything agent. And oh, by the way, I'm supposed to sell something, I’m actually supposed to have meetings where I go in and actually sell. And where I’m spending my time is everywhere but that. And so as we eliminate layers of management and flatten the organization structure and increase responsibilities, I’ve found that I'm selling 15%, 20% of my time. And I'm busy doing all the other stuff, fixing invoices, trouble-shooting something. I try to dish off a lot of work. We actually have an admin here now. So I would say in the last five years that I went from being, really, I spent a lot more of my time selling to now spending a lot less of my time selling. Somebody at Medtronic is eventually going to listen to this. But it's the law of forced efficiency. At some point, something's got to give. Every once in a while, I make a conscious effort not to be in the lab, I’ll send a clinical, and I try to do, all the menial stuff I try to push off to my technical team, to my service team. And I try to make sure that I'm focusing on high value activities that are going to lead to a bulk deal at the end of the quarter or is going to lead to further adoption of a product. You know what I mean, selling more clinical indications that people understand maybe with that device like LINQ, for example, to increase utilization, which ultimately leads to more sales. With companies looking for cheaper labor, we moved the answering service overseas, and it just seems like I'm doing more of everything and selling happens to be the one I am measured on. But it seems like this, and this is probably just corporate America in general, but it's to the point where that part of the job, I’ll spend the last week of the quarter in my office just cleaning everything up.
Pat: PO’s and all that?
Jeff: Yeah, and I never used to do that. It's been the last day or two five years ago. It's just the more you do, the more mess you create even though you have a tight, clean workspace and everyone's got best practices in their jobs. All this stuff builds up. So I'd say that's been a huge shift on top of, your company wants more from fewer people. And that's made this job hard. I think there's been discussions internally that this job has turned into a bit of a monster. It's a big animal. And I do know of reps that have negotiated agreements to be off call completely. They just don't do call anymore. You can't ask me to do $20 million and be on call. I can't do it. And they’re, you know, you've been around the block. Imagine trying to manage ten, twenty million dollars and being on call too, you know what I mean?
Pat: It’s not easy.
Jeff: Right. So I think that's where the job’s really changed. We've got less resources in the field, the company's reduced the quality of the individual in house that you deal with, there's more turnover in these customer service call center type areas, and so, every once in a while you find yourself educating a person how to do their job. I had somebody from the compliance group contacted me about a device that they claim was malfunctioning. I wasn't even involved in the care of the patient. It actually went to our call center, but since it was in my territory, they asked me to comment on it. So I'm reading through this thinking, this person has no idea that they're looking at something that they don't understand it. Because if they understood it, there's not a problem here at all, so I was kind of mad. But after thirty minutes, I realized, you know what, there's a couple of ways I could respond to this email. One, I'll probably get on somebody's radar, and that probably won’t be good. So I'm going to educate this person about why the device is doing what it did, and that actually it's considered normal device function. And that you could have an arrhythmia that can go from afib (atrial fibrillation) with RVR (rapid ventricular response) in a low ejection fraction and trigger a true ventricular tachycardia.
00:55:06 - 01:00:11
So I'm having to explain all this, which was a pretty technical explanation, and what I got back was, thank you for that, Jeff, I really appreciate it. But at first, you're enraged because these people that used to look at MDR events and reports used to have the education that you and I had. They were NASPe certified or Heart Rhythm certified, and now they don't have that quality of individual. Now you've got to take thirty-five minutes to answer an email that as soon as you look into it, there's nothing, this is normal device function, this is not anything that's reportable.
Q: What, if there is something, is there something, one thing driving the EP space right now, either the EP space or specifically cardiac rhythm? What's going on in that space right now? What's new, what's exciting, what's everybody focusing on?
Jeff: Well, one, hospitals are focused on cost containment in that space because the growth is tremendous. Look at the aging of our population. People are living longer and the longer you live, as you know, you're more susceptible to arrhythmias and heart valve issues that lead to heart surgeries which lead to arrhythmias, which lead to pacemakers. So this space is interesting. So there's more and more patients eligible for treatment, so that's one. Right now, if you're an electrophysiologist coming out of fellowship, you've got five to six offers. It's incredible. They can choose where they want to live right now. Put a finger on a map, someone will write them a check to come move there and set up shop. But you know, it's a dynamic space because everyone is looking for miniaturization is coming into the space and there's some really cool drugs out right now. But as you know, the drugs eventually fail or don't do their job the way they should. And so, ablation has kind of really taken off and new ablation technology, mapping technology, image-guided technology is really become big. Entire companies are built on that, as you know. St. Jude, Abbott is a leader in that, you got a J&J company, as you know, in that space. So the EP side, the non-device side, has tremendous growth at Medtronic. The AF Solutions group, they're coming out with all sorts of new types of ablation technologies that are faster, safer, more efficacious. But I just think the number of treatable patients continues to grow and I think the adoption of computer control and de-miniaturization of technology, the sensor gig. Think about your iPhone, it’s more powerful, it’s a supercomputer. Remember the craze, the supercomputer was in all your case studies in business school? You got a supercomputer in your back pocket, it's called an iPhone.
Pat: It's true.
Jeff: Same with Samsung Galaxy, right? So I think that stuff that's going on is, they're looking for ways, how do we, like our micro pacemaker, a pacer that goes through the groin and sits inside the heart, period, and lasts ten to twelve, thirteen years. That part of the space is going to continue to go where we're going to, if you're not going to obsolete yourself, someone is going to obsolete you with another technology.
Pat: Good point.
Q: So thinking back on your career, it doesn't have to be the role you're in now, but any of the previous roles, is there a case that you've been in that just stands out as just the most unbelievable situation that you can remember?
Jeff: Oh, absolutely, I’ve got one. I call this procedure the enemy of good. I was working at a major Michigan institution, world renowned thoracic surgeons there. And we are using the Davinci robot to do a lobectomy.
Q: Can you explain what a lobectomy is?
Jeff: A lobectomy is removal of a lobe of a diseased lung. You're not removing the whole lung, but you’re removing a section of the lung, disease, cancers. And so you're working in the chest cavity but the cavity is closed. We don't have an open incision, the robot is going through trocars between the ribs, so you’ve got access ports. And then we had a port that the Fellow was accessing through using what’s called a surgical stapler. And this is a situation where the technology, the visualization technologies of Davinci was stereoscopic, 3D, high def. And with that, if you compare what we were doing before that, it was just the standard 2D camera on as you know, a Sony display monitor. And so these guys, when they're looking through that console, it's like they're inside.
01:00:11 - 01:05:00
They've immersed themselves in the body in a way that wasn't previously capable. And we had like a ten and fifteen, I might be wrong on this, but it used to be a ten to fifteen x magnification in that camera head. I remember giving a Cleveland Clinic surgeon 7-0 suture on a BV-1, this little tiny needle. And he looked at it through the scope and he said, what did you give me, this is a harpoon. (In the world of suture, the more zeroes the smaller the suture. So think of 7-0 suture as having 7 zeroes. Cardiothoracic surgeons typically use 7-0 or 8-0 suture to do an anastomosis on the heart, which is attaching one blood vessel to another. This is what happens in a bypass procedure. I believe the smallest suture is 11-0 or 12-0. Just for reference, a 7-0 suture is about the size of a human hair) That’s the same thing you use when you're wearing your surgical loops and you’re anastomosing the LIMA (left internal mammory artery) to the LAD (left anterior descending artery), it’s the same needle. He's like, this is amazing. He goes, this thing looks like a giant harpoon, and I know it’s this little tiny thing. So just think about that in relation. Now, we're in this case. We get what we think is a diseased lobe out. It's in a bag ready to be pulled out of the chest cavity and we do pull it out of the chest. And the physician, having such phenomenal vision, looks around and goes, hey, there's this other aberrant lobe over here or part of the lung, we should go get it. Now I will tell you, okay, let's go get it if you think we can get to easily. But the one caveat was we had to go past our previous staple line, so we needed a different stapler. We had kind of like the Ethicon, J&J. Remember, you guys had the straight vascular stapler?
Jeff: So then we got to go to the L shaped stapler. You know what I mean, they used a lot like in the pelvis? So when the Fellow is bringing the stapler in the chest cavity and bringing it past the previously stapled part of the lung, they ripped open the previous staple line, and straight at the camera comes a flow of blood just like a hose, and I can still see it in my mind’s eye. And a couple of expletives were said by the surgeon. The Fellow knew right then that, okay, now we have a life or death emergency. And I ran over and I hit the emergency stop button on the robot and I jumped into the surgical field along with these guys as the surgeon jumped from the robot, opened up the guy through the ribs, emergently. And now I'm pulling the robot out of the chest, contaminated field, but at this point we have to save the guy's life because he's going to bleed right out of his chest cavity. And all of a sudden, four or five anesthesiologists are just there and they're ringing bags of blood back into this guy, bag after bag after bag blood is being brought in, and he's bleeding out. So that was probably to this day, the largest single most disaster of a procedure. It actually stopped robotic surgery at that institution for two months while they reviewed the case and everything that we had done. The physician and I, we went out for a beer that night and he looked at me. He goes, you know, this is a case where the technology is so good that the enemy of good is better. I should have left it alone. He goes, I would have never seen it, and we could have irradiated it, treated it, you know. He just said to me, you know, that's where the tool is so good, but is it advanced beyond that guy assisting that Fellow, right? The Fellow’s got to do crazy stuff to get that stapler around and get in the proper position, right. And it was a crazy case.
Q: Jeff, what advice would you give someone that thinks medical device sales is where he or she wants to be.
Jeff: Well first, I think from experience medical device sales companies want to hire people with sales experience. I think you have to become a very sound salesperson, one that understands that their role is very consultative. And that if you have a transactional mindset, to be closer, I’m going to close, close, and I'm going to use closing language all the time, you're not right for this field. But you have to have sales experience. Without good sales experience, you're going to be overwhelmed trying to learn how sell, because you won't be able to understand your own technology. So I think you’ve got to get sales experience before you attempt to come in. And then you got to network like crazy. And find a recruiter, certain companies like that young, copier, right, or someone who understands the grit of selling. J&J likes that.
01:05:00 - 01:09:40
They like to hire those kids, couple years of sales experience, early twenties, mid twenties. So you have to understand who hires. Pharma companies, do they hire cheerleaders or do they hire sales people? What's the hiring profile of the company? Take a look at yourself, ask people you're close to, do a 360 of you and say, maybe get a mentor. Find someone that's already in the space and have coffee with them, you know what I mean, befriend them, network on LinkedIn. And these people might be able to steer you in to something that fits your needs. But if you're not able to sell, you're not fundamentally just a good salesperson, I think you'll struggle. You gotta know how to close, but you also gotta know how your technology applies and how you can leverage all that you know, how to close. Because we have clinical specialists here, there's some clinicals that understand I have a hard job, you’ve experienced that. Some that think they can just do your job, your job is easy. I think the proof is when I went off for eight weeks at the end of the fourth quarter two years ago and sales plummeted to their lowest in twelve or thirteen quarters that the rep mattered, right? Even though I had a very strong clinical team…
Pat: It’s not sales.
Jeff: Right. So get sales experience and get it any way you can. Get it in fields, medical companies like difficult sales. They liked copier guys, they like people that sold pharma or something technically difficult.
Pat: Right. That's actually where I got my sales training, at Lanier selling copiers.
Q: What would you be doing if you weren't doing this?
Jeff: Oh boy. Are you saying I have enough money that I don't have to work anymore.
Pat: No, no.
Jeff: It's interesting. I think I would still be in something scientific, although a part of me thought I should become a real estate developer or homebuilder. I’ve always just been fascinated by how to build a house. So I might have become a home builder.
Pat: That would be interesting.
Jeff: But with the homes I think I would have built would have been green homes. They would have been homes that use low energy, renewable resources, things of that nature. Something I've always thought about.
Pat: Okay, cool. How can people find out more formation about your company?
Jeff: www.medtronic.com. There’s a wealth of resources there. There is also a Medtronic YouTube channel called Medtronic Cardiac (https://www.youtube.com/user/MedtronicCardiac). I think they probably have a YouTube channel for every division, but Medtronic cardiac is where a lot of things I sell resides. Lots of videos on how they're used, how their applied. I think that it's, but the web's a great resource. The company has tailored the web experience to patients, technical users, and clinicians, as you’re well aware. You could find really, and if you're looking at maybe getting into this space, within Medtronic we created an academy that's open to the public. It's called MedtronicAcademy.com, where you can create learning plans for just about every space. You can learn the fundamentals of pacing, you can learn the fundamentals of stenting, you can learn the fundamentals of cardiac surgery, you can learn the fundamentals of diabetes and drug pumps and things of that nature, so that's a big resource.
Pat: That's great, that's very helpful. And what about you? Are you on social media? Is there any way people can connect with you?
Jeff: Yeah. I kind of abandoned Facebook, I have a profile you can probably find, but I don't keep it active on my phone. But LinkedIn is where I could be found (https://www.linkedin.com/in/jeff-george-7a980b1/).
Pat: Okay. All right, and I’ll put all of that information, the Medtronic.com and the YouTube channel, and your Linkedln profile, I will put that information on the show notes.
Jeff: Okay. Great.
Pat: Well, Jeff, we're just over an hour here, so I don't want to take up anymore of your time. But I do very much appreciate you participating and I appreciate all of the insight. I imagine there are going to be quite a few people that get a lot of good information from your talk, so thank you for joining us.
Jeff: I appreciate it, thanks for your time.
Pat: Take care.