From Corporate Goliaths to Startup Sparks: Insights From Medtech's Top InsiderFrom Corporate Goliaths to Startup Sparks: Insights From Medtech's Top Insider

Scott Nelson, one of the medical device's top insiders, stops by to discuss the trends in the industry and to give tips to entrepreneurs looking to jump into the world of medtech. Nelson is the co-founder and CEO of FastWave Medical, a medical device startup developing intravascular lithotripsy systems for cardiovascular disease. Additionally, he’s the founder of MedSider, where he interviews founders and CEOs of promising, early-stage medical device and health technology companies. 

Below is a transcript of a portion of the conversation on Let's Talk Medtech.

Omar: Well, Scott, welcome to Let's talk Medtech. It's a long time overdue, but I'm, I'm glad that you're on the show.

Scott: I'm definitely looking forward to the conversation. Omar, I appreciate you having me on, and yes, it's overdue, but it should be a fun, fun conversation. Lots to talk about.

Omar: Yeah. Yeah, I want to get all into your work at FastWave Medical and what you do there. And also, I want to talk a little bit about MedSider, you know, your podcast. But first, how did you get into this crazy industry that we call medtech? How did you even start here?

Scott: Yeah, well, I won't go too far into the weeds, but I'll share a short story. So, like, I mean, this is, this is, you know, I guess I'm dating myself now, but, you know, almost 20 years ago now, you know, I was. I was premed in undergrad. Um, ended up finishing, finishing with a degree in biology. Thought I wanted to become a doctor, you know. So, um, now I get to play one on tv, I guess, right? But. But joking aside, I, uh, I did everything, you know, gearing up to med school, uh, kept my GPA super high. Um, did all the extracurricular activities and took my MCAT, but just didn't feel like ultimately it was for me. Uh, and so, um, right out of undergrad, I ended up landing in um, in the, in the device space. Uh, my mom's been a nurse for, uh, she's retired now, but she's, she's been a nurse for most of her, her career, and knew a fair number of, of reps that kind of called on their, their gi lab. And so that's sort of how I came into the industry and I've been, I've been really involved ever since, um, spent the first half of my career, um, with large strategics, uh, barred peripheral vascular, which is now, uh, uh, under the Beckton Dickinson umbrella, as most people know. Um, spent a little bit of time at Boston Scientific, ended up coming into Covidian through their acquisition of Bacchus vascular, which was a Tom Fogerty startup.

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Omar: Oh, wow.

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Scott: Yeah, I like to say it was, I was, I was involved with thrombectomy before thrombectomy was popular, but, yeah, so the first time, you know, at the highest level, you know, spent most of my career in medtech, primarily within the cardiovascular space, first half with, with large strategics, and really kind of over the better part of a decade now, most of my time has been spent with, with early-stage startups.

Omar: What led to that switch? Well, not kind of, but why did you move to startups and take an interest in them?

Scott: Yeah, and I think it's one of those things that, personally, I've always sort of had a bias towards the world of like the entrepreneurial world, towards startups. It's always something that I've been sort of fascinated with. This probably fits my personality, my neat personality, and I think that's actually an interesting topic that, you know, I'm not sure how deep we want to go, but, you know, are sort of like people that are involved a lot, or serial entrepreneurs, people that are involved in startups. Is it sort of, is it sort of built into their framework? Right. Or is it something that you can kind of learn? I don't know if I have a definitive answer to that question, but, you know, I think most people that thrive in a startup environment because of the pace, because of sort of the idea of being comfortable, being uncomfortable, if that, if that makes sense.

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Omar: Yes, it does.

Scott: I do think it's, it does require kind of a different, different breed. Right. Of a person. Uh, for sure. There's no doubt. Can you learn out all that and pick all that up, certainly, you know, um, but I definitely think it's not for everyone, for sure. And so, um, you know, I, even though I spent, uh, the first half of my career with large strategics, which was a phenomenal learning opportunity, in fact, it's something that I encourage a lot of younger folks in their careers to, to spend time inside a large organization. Even though it can feel bureaucratic and slow and onerous, it's, it's, it's an incredibly valuable learning experience. Um, you know, I always had that, that kind of bias. And, um, you know, after I'd spent a little bit of time at Covidien, um, and then even a little bit of time after Medtronic's acquisition the company in various roles, um, you know, the opportunity presented itself to kind of, you know, take, take a leap. Um, with, uh, it was touch surgery. It was the kind of the first startup that I was involved with was a London-based digital health startup that was later on required, uh, acquired by Medtronic. But, you know, the opportunity presented itself, um, great. Kind of founding, uh, team doctor Jean Neme and Andre Chow. John is actually a, you know, still very much in the entrepreneurial game. It just kind of. Right, opportunity, right team. And so I decided to kind of take, take that leap. But, you know, gosh, that was back in almost a decade ago now.

Omar: Yeah, you've rattled off some impressive names. I mean, Medtronic, Covidien, you know, bard companies you've been, you know, involved with, so to speak. And I'm wondering now in your career at this point, how does it feel to have been a part of some of those names that have been acquired? Right. Cause Covidien was acquired by Medtronic back in what, 2014, 2016 or so? 2014, I believe we can always go back and check, but just to be part of those brands that are no longer here, I mean, that's, you know, that's a part of Medtech history. And I remember I came into the industry back in 2007 covering it as a beat reporter. And a lot of the companies that used to exist when I started out, they know they're no longer around, you know?

Scott: Yep, yep. It's funny, I mean, for kind of OGs, like, like you and I right there, but in the space a bit. Yeah. It's funny because I look back, like earlier on in my career and, you know, you'd hear names, you know, just us, surgical as an example, like legacy names we talked about. It's like, huh, what, what's that company that seems like I've never heard of that company, you know what I mean? And so now I'm kind of at that point in my career where it's like you toss around names like Bard and Bard peripheral and cavitation. It feels like home to me, but it's probably foreign to younger med tech folks. But to answer come full circle on your question, which I think is a great topic or something to bring up, especially for those that are biased towards startups, looking back, I'm much more appreciative of my experience there at those strategics, and I referenced this when I was riffing on the arc of my career, but when you're in a large company, it can feel kind of stifling. It's very bureaucratic, a lot of layers, so many people. It's a decision by committee, et cetera. And again, I'm not saying that that feels good or there's not a lot of friction in that sort of environment, but if you take advantage of it, if you're proactive about trying to touch a lot of different functions and getting to know a lot of different people in various departments and organizations within the larger company, it can be really, really beneficial. And so I guess for those listening that are kind of at that point in their career and are kind of debating on whether or not to make their next move or go to a startup, just think it's not all that bad if you're in a strategic and there's not a next move. I would encourage everyone to take full advantage of where you're at and just get involved in, try to do your best to get involved in a lot of different initiatives, a lot of different projects, because that's one of the unique advantages of being at a large strategic, is that, you know, there's a lot of things going on, for sure. And most of the time, you know, you can, you can get involved if you're proactive about it.

Omar: Well, let's talk about now your work at fast wave medical. Now you're the co-founder and CEO. Talk a little bit about, and walk us through what FastWave is doing now.

Scott: Yeah, so we're designing. Well, I guess let me take a step back. FastWave, it's a relatively young company. We actually spun it out in early 21, so not quite three -years old at the time that we're having this discussion. So pretty young company, but fast-moving, right? The name's Fast-moving by intention. And so we're designing and developing intravascular lithotripsy systems. So IVL is the acronym. IVL. It's the acronym that's often used, or that you'll see the only incumbent in the space is a company called Shockwave Medical.

Omar: Yeah.

Scott: Yeah. Which is a unique, a really unique story. You rarely see kind of a standalone startup that's IPO'd and has grown at kind of the pace and succeeded like they have. So, you know, kudos to their team, but we're developing similar, I guess, systems in that same category. Right. That intravascular lithotripsy category. And for those that aren't familiar with this technology, I'll kind of, I'll talk about it on a high level. We can certainly go deeper, but it's in the cardiovascular space, right, where these devices are meant for peripheral, or at least ours are meant for peripheral and coronary applications. And really, you know, think about it like a plumber, right? You're. You're trying to open up a blood vessel, open up a pipe, right. That's clogged, that's burdened. Right. In this case, it's. It's. It's calcific, you know, really, uh, uh, challenging calcific disease that's causing that blockage. And intravascular lithotripsy. Is a newer therapy that, in essence, uses shock waves, uh, um, uh, that are delivered through. Through a balloon, through an angioplasty balloon, uh, that break up this. This. This, uh, plaque. Right. Causes fissures or plaque. And by breaking up that plaque, you're allowed to kind of further expand the vessel to increase blood flow. And so, again, that's a very high level, kind of somewhat rudimentary, you know, characterization of IVL, but hopefully that gives. It gives a, you know, kind of level, sets everyone from. Everyone listening to that isn't familiar with the space.

Omar: Interesting, interesting. Yeah. And, you know, you all have been doing incredible work there, and I think late last year, maybe middle of last year, I don't know, 2023, went by like a blur to me. But I remember you raised, you had a funding round, and that came in a particularly, I'd say, stressful environment when it comes to garnering funding. And, you know, I don't want to delve too much into that, but I want to talk a little bit about just startups in this day and age, really trying to navigate and get that funding and support now. Any tips that you can give them?

Scott: Yeah, no, it's a topic that we can certainly go deep on because it's something that I bring up quite a bit when I chat with other founders and CEO's of startups, but just to touch on FastWave. So just looking back, we closed our Series A round of financing back in 2021. That was a $12 million Series A round of financing. And then, yeah, to your point, you're dead on. In 2023, the summer of 23, we closed on another private placement. Um, and what's, what's probably unique about that story, and it'll, it'll, it'll segue into answering your question, but we raised um, you know, close to, close to nine figures in Rev in the capital, uh, with. In less than a month. Right? Uh, yeah. And that was, most of it came from the physician, uh, Kols. So KOLs within the cardiovascular space. And so to be able to close that amount of capital in that short amount of time in that funding environment. Right. I mean the funding fundraising is never easy, but especially in 2023, it's exceptionally hard. I think it just speaks to one is the overarching interest within the physician community for more players to be involved in more options with respect to intravascular lithotripsy. So I think that was obviously a good sign. But secondarily, I think when you have really, really world-renowned Kols writing personal checks, I think it's a signal to the confidence they have in our team and our ability to move quickly. And so incredibly grateful to have a group of KoLs and really other industry stakeholders involved in that private placement. But to answer your question, Omar, I think the funding environment, again, like I said, is never easy, but it's changing quite, quite quickly, especially as kind of the VC. The traditional venture capital landscape continues to change and LP's limited partners in those funds demand different things or asking different things of the venture firms that they're investing in. And so the main message, and really the main takeaway I have for entrepreneurs or founders and CEO's that are looking at their next round of capital or in the midst of trying to raise it, is go far and wide. The onus is on us as leaders of startups is we can't just rely on a small cohort of traditional VC's to effectively raise our next run of capital. We really need to go far and wide. What I mean by far and wide is don't limit yourself to the top five or ten VC's that traditionally invest in your space. You need to go out and talk to high net worth individuals, angel investors, people that could put together an SPV, um, there's a lot of physicians, um, in, in your space, um, and, and, or other industry folks right in your therapeutic, uh, kind of domain that may have an interest in investing. And so I think just the, the main message I have is, is, you know, keep all your options on the table and really go far and wide. It's a lot of work. There's no doubt. In fact, it can feel almost like your full-time job. Right. And it probably is for most founders and CEO's. But, you know, that's just part of the game. That's sort of the world we're living in, is that we need to go far and wide and create a lot of, of, hopefully, a lot of interest in demand and kind of the, uh, that the company that you're building.

Omar: Yeah. You know, I was talking to entrepreneur Marissa Fayer, and she's also the founder of HerHealth Eq. And I remember last year, we were talking about looking for funding, and I said, oh, it's pretty, it's pretty simple to get venture capital these days, isn't it? And she kind of just looked at me, she said, I don't know what world you're on, Omar, you know, shout out to Marissa. She's a good friend of the show and has been interviewed here many times. But the point is with that is that it seems as if the traditional methods, or the, I want to use this term, easy method or conventional method of going to venture capitalist isn't what is going to sustain entrepreneurs now. They have to look for a variety of different sources. And to your point, you said, look for those angel investors. And I can remember where angels were thought of as a bad thing, not a totally bad thing, but it's like, oh, nobody else will invest in you, so you go to angels. But we're, I think what we're seeing now in the industry is we're seeing companies like Simbex have contests, right, to fund entrepreneurs in their work. We're seeing intuitive surgical create a venture or a VC arm. We're seeing a lot of these players come in to kind of fill in the gaps and help these entrepreneurs, help these startups get to the next level. And it's truly a hodgepodge of funding. It's not just VC funding and the occasional grant anymore. It's just a smattering of .. a smorgus board of financing now.

Scott: Yeah. And I think it's across all stages, right? I'm even seeing later round Series C, Series D rounds being put together, you know, with a kind of, maybe an atypical syndicate, right? So, like, on this note, there's probably three kind of, you know, sort of significant trends that I'm seeing you know, sort of being, being deep in the, in the you know, fundraising. I mean we're raising our series B right now for FastWave.