FITM Extended Interview: Charlie DeCook

Charlie DeCook has exited seven medical device companies while performing 1,500 joint replacements a year — all packed into three clinical days per week. In this extended interview, he breaks down exactly how he evaluates new technologies and why he now filters every opportunity through an AI and robotics lens.

DeCook traces his entrepreneurial arc from his first venture in surgical impaction — a product that eventually sold to Johnson & Johnson and became Kincise — through to his current focus on software-driven solutions. He explains why the "jobs to be done" framework from Clayton Christensen's Innovator's Dilemma is the foundation of every product he touches, and why surgeons who skip the financial model are setting themselves up for years of pain. Along the way, he offers a candid look at how large device companies operate, including the "slow no" that strings inventor-surgeons along for months without a real commitment.

The conversation also covers the AHF Shark Tank program and what separates pitches that land from those that get eaten alive. Whether you are a surgeon sitting in the OR frustrated with an inefficiency, or a founder trying to get traction with the big three, DeCook's hard-won playbook is worth hearing in full.

⏱️ Chapters:
00:00 Meet Charlie DeCook — surgeon, serial entrepreneur
02:11 First venture: surgical impaction to Johnson & Johnson
03:29 Filtering ideas with easier, faster, better
05:22 Patient outcomes vs commercial reality in med-tech
07:43 Why cost concerns work themselves out over time
09:02 Strategic shift from hardware to AI and robotics
10:41 Finding innovation through jobs to be done in the OR
12:43 Lessons from ventures that required major pivots
14:49 Protecting IP from large device companies
17:27 Why public companies can't think past the quarter
19:02 Evaluating products beyond your own efficiency lens
21:40 What makes a winning AHF Shark Tank pitch
24:29 Common mistakes surgeon-entrepreneurs make pitching
27:17 Innovation areas the Shark Tank needs more of
29:25 Top advice for surgeons with a great OR idea
31:45 What innovation in orthopedics really means

Listen to the AHF Podcast on your preferred platform:
Buzzsprout: https://ahfpodcast.buzzsprout.com
Apple Podcasts: https://podcasts.apple.com/us/podcast/ahf-podcast/id1749521487
Spotify: https://open.spotify.com/show/5CrGJyvRiQFTCU3FFFVvHc
LinkedIn: https://www.linkedin.com/showcase/ahf-podcast
YouTube: https://www.youtube.com/@anteriorhipfoundation
Homepage: https://anteriorhipfoundation.com

This podcast is intended for educational and informational purposes only.

The content discussed does not constitute medical advice and should not be used as a substitute for professional judgment. Clinicians should rely on their own training, experience, and clinical decision-making when applying information from this discussion.

#AnteriorHipFoundation #AHFPodcast #SurgeonEntrepreneur #MedicalDeviceStartup #OrthopedicInnovation #TotalJointArthroplasty #SurgicalImpaction #AIinOrthopedics #RoboticSurgery #JobsToBeDone #AHFSharkTank #CharlieDeCook #MedTechEntrepreneur #THA

Transcript

Charlie DeCook 0:26

My name is Charlie DeCook. I'm the president of Total Joint Specialist, a 17 surgeon Group here in Atlanta, Georgia. I'm super excited to be on the AHF Podcast today.

Joseph M. Schwab 0:37

So Charlie, you have an impressive, we'll, we'll say entrepreneurial track where you've uh, I think successfully exited seven companies. Um, and I want to ask, as a busy surgeon. How do you find the time and motivation to be a serial entrepreneur?

Charlie DeCook 0:56

Uh, I think you have to create time. You know, we, we go to what's most important in our lives. And for me, the ability to create, uh, to create new markets, new products is the most exciting thing I do. I mean, I'm, I like operating. I've been a surgeon for a long time now and do lots and lots of surgeries. To be honest with you, my main passion now is about, um, disrupting markets, creating new technologies. Um, I think that's gonna be kind of my lasting legacy, is that, so I'm super focused on that right now. To give you an idea of kind of how I divvy up my time. I do about 1500 joints a year, but I do that all at about three days a week. So, you know, a as you know, you know, efficiency is super important to me. So I want to totally value the time I use and spend. So I put all my clinical practice into three days a week, and then the rest of the time, I mean, weekends, nights, I mean, this is just what I love doing is learning from other founders. Learning, uh, what's in the market and kind of developing new technologies, that's what really drives me.

Joseph M. Schwab 2:10

Can you tell me a little bit about your first venture outside of your clinical practice? How did you get involved in this?

Charlie DeCook 2:18

Yeah, the first one, um, really wasn't my idea. So the idea of surgical impaction came from a, a very dear friend that's actually become my real mentor in life, at least from an entrepreneur perspective. They came to me with this idea that they had been working on for about six years already. And, uh, really I just helped along the way. Um, I, I found out that I was pretty good at storytelling and, uh, that storytelling really helped us sell the product. Um, the product sold itself, but as you know. You can't just have a good product. So this one happened to be surgical impaction and uh, it was, uh, called Medical Enterprises and it eventually sold to Johnson and Johnson, I think maybe, gosh, I think seven or eight years ago now. And it became what we all know now as concise. Both Concise one and concise 2.0. So, um, that was kind of the first real successful exit for me, um, was that product right.

Joseph M. Schwab 3:28

Walk me through the DeCook filter. So when an an early stage idea comes, uh, you know, comes to you, how do you determine if it achieves that sort of holy grail trifecta of easier, faster, better?

Charlie DeCook 3:43

Ah, yeah. Easier, faster, better. Yeah. The, the book that everybody knows is smarter, faster, better. And, you know, I never was that smart, so I thought easier, made more sense to me. Um, honestly, my filter has changed over the years. I used to be so excited by so many products. I mean, you'll hear Steve Jobs talk about this all the time, which is you have to have the discipline to say no to a lot of great ideas because there are just a ton of great ideas that surgeons have that engineers in our, in our medical device space have. They're just fantastic ideas, but I think, you know, reality hits and you realize there's not really a market for it or nobody's gonna buy it. So, uh, my filter has totally changed. I would say yes to just about anything, you know, eight to 10 years ago. And I'd just say, yeah, I'd love to help you with it. Let's develop it. Let's bring it to market. Now I'm super, super selective and it's really based on the market and where I think the market's going, right? If it's not ai, if it's not robotics in some way, then I'm really not interested. Um, you know, the. The market, not just a medical device, but obviously the entire world is going to this AI and robotic space. And if it is not touching one of those two things, then we probably shouldn't be doing it. So, uh, it's, that's my filter now. I mean, if it's not AI related or if it's not, um, somehow related to, uh, a robot, then I'm not that interested.

Joseph M. Schwab 5:21

So you also emphasize that innovations, or you've emphasized in the past that innovations drive greater value. They have to drive greater value for patients and, and healthcare. And how do you, uh, when you're looking at these new technologies, ai, robotics, whatever you're looking at. How do you weigh improved patient outcomes against, we'll say commercial necessity and cost?

Charlie DeCook 5:47

Yeah, well, I think probably surgical impactor is the best example of this, where I think people get the wrong idea. When we were developing the impact, or there's a lot of people and academic people saying, Hey, listen, you have to prove out that this thing creates less fractures, that it does this or that, or look at ergonomics or things like that. And they took a very appropriate, uh, stance, which is, Hey, you need lots of research to prove out these things. But we knew fundamentally the reason why surgical impaction would be adopted. It's'cause frankly, it made it simpler for the surgeon. It's, it may not ever prove out that it's better for the patient. As long as it, as long as it proves out that it's at least as good as using what we've been using for 3000 years, which is a, you know, a mallet or a hammer, then I'm good with it. So I think this idea of bringing value to the patient is great. Oftentimes when you bring a product to market, even successful products, other products that we sold that have become successful. Even when you do that, it's hard to ever prove out it does any better to a patient. Let's take for exa example, first generation robots. Look at all the money that is spent on first generation robots in the hip and knee space, and there's been never any conclusive evidence that does squat to help the patient one bit, right? It's all been about capitalism, market share. That's what it's truly been about. Now, do I think in the future, do I think robots are going to help patients? I do, but that process takes forever. You know, it just takes so long to prove these things out, right? We're eventually gonna prove out that a robot does better than manual instruments for a hip or for a knee, because we're gonna eventually know where the target is. We all know that robots hit a target better than we can manually, even with the fluoroscopy and anterior approach, but that just takes a long time to prove out. It's same with the overall cost, structure and value, right? People always freak out about the cost of a particular technology early in in the lifecycle, and I never really worry about that. I always think back to when my dad bought his first. Flat screen TV and it was like$10,000. I mean, it was ridiculous in like late eighties, early nineties, right? He was willing to spend$10,000 on the stupid tv. Right. And what do we get'em for now? I mean, we can give'em for like$400 on Amazon. Right. So the great thing about, uh, Adam Smith taught us about the invisible hand of capitalism, which is it eventually pushes competition to the point where those, the value will find itself. So always when I start with a product, I always start with a big vision. And those other market pressures will work itself out like finding, um. The right thing for the patient. Finding the overall value, that stuff eventually works itself out in the market. Your job to bring in new product to market is not to worry as much about those things.

Joseph M. Schwab 9:01

So you mentioned AI and robotics. Why the strategic shift from, say, optimizing physical devices to these sort of more digital solutions? Is it just the market that you think is driving that way, or are there other factors?

Charlie DeCook 9:17

Well, physical is harder, right? So we've sold multiple companies that are physical products, right? They're um. Hardware, they're difficult to do. They're expensive to make. Um, it, it is a much harder company to form around a hardware than it is a software. Just ask Elon Musk in creating a car manufacturing, right? That is a ridiculously hard thing to do, right? It costs, it's lots of capital to do it, and software is just so much easier to do. Now there's obviously a lot of downsides to software. Software will, will, will ru rule out every single time. Um, I, I just think with AI today, there's just so many incredible things AI can do for us that everyone has to pivot there now, as long as you supplement it with something else, I don't care if you're gonna create a new hip stem or a new knee femur or whatever the case may be. It just has to be supplemented with something AI related. Right. It has to either work with a new robot or it has to be related to those in order for that to make sense in 2025 and beyond.

Joseph M. Schwab 10:30

Hmm. So is it your work in the operating room that inspires your innovations or do you try and keep those separate?

Charlie DeCook 10:40

I think they totally inspire me because I, I am so terrible at picking products outside of orthopedics. Like, forget it, like you ask me anything in general surgery or, uh, you know, dermatology or anything outside of healthcare, I just suck at it. Right. You, you develop this inner instinct of what will work and what will not work in an operating room. I think. I think the moment I ever try and, you know, work with products outside of that, it fails every time. So, um, for me, I do get all kinds of inspiration and it's really based on the work of Clayton Christensen and his innovator's dilemma. And he, you know, he. Basically has the theory of jobs to be done, and that is every surgeon has a job to be done in the operating room. And it's funny to me how many products get this wrong? They don't really look at what we are actually doing in the operating room. You could tell, you could see all these products that even make it the market. You know, they may even be bought by a large company, but they end up failing because you fail to recognize the job, the true job to be done, right. We're hiring products all day long in our operating room to do a specific task like impacting. Right. Surgical impaction is the perfect example of that where, listen, I've been hiring this hammer for, you know, my entire career, right? And no one ever thought to question that job to be done, right? Same with everything else, like how you look at a cup, or how you look at soft tissue tension, or, you know, whatever the case may be. We're hiring things all day long in the or. Can we look at that job to be done a little bit differently than we did before? And I think that's what Elon Musk has done a great job of. You know, if you think about the satellites he's put up in the air, if you thought about the chip, he's put in people's brains. I mean that that kind of looking at things from a different perspective, I think really is the key to having a unique, innovative product.

Joseph M. Schwab 12:42

Hmm. Is there a venture that you've participated in that didn't really go as planned? And if so, were there any lessons you learned from it?

Charlie DeCook 12:53

Knock on wood there has not been yet, so don't jinx me here, Joe. I'm sure it will happen. I think good old luck will eventually run out for me. Um. And I think probably the reason why is that we continue to just be super focused and I will not quit until we got a product that works. And oftentimes that product changes, right? Um, we have an initial idea that's like, oh yeah, that made a heck of a lot of sense. Kinda like, um. Airbnb is a perfect example, like Airbnb and those guys came out with this idea for just one weekend at a conference to rent an air mattress, and they called it a bed and breakfast, right? And that name still sticks today, right? They thought this was a one weekend thing to help pay them rent for the month, right? And they were working on what's the next big idea, and they didn't realize that they had that big idea the whole time. Now they pivot away from an air mattress, right? They pivot away from. From a lot of the core idea over time, and you'll see that in almost every product that comes to market, there is one or two major shifts or pivots when they realize that wasn't such a good idea. There's, there's one part that really makes a hell of a lot of sense, but really we're gonna have to super pivot right now and make a different product. Um. So that's happened in, I would say the majority of companies we've eventually sold. There's been a few that have been dis same the entire time. We didn't have to make any pivots, uh, because of market pressure. But oftentimes, listen, you have a great idea and product, but there's market pressures that start to happen, and then you realize, oh gosh, you know, AI is here now we, we no longer need that particular product, right? Or in the world of robotics, why in the world would I develop manual instruments anymore? That kind of thing.

Joseph M. Schwab 14:48

so speaking of that, you've, you've also successfully leveraged collaborations with some large established industry partners, and if you were to give some specific advice for things like protecting your intellectual property and maintaining control of your core innovation while you're working with large device companies, what advice would you give?

Charlie DeCook 15:13

Oh boy. I've got a ton here and I'm, I, I need to do this. So I, so, I'm politically correct here. I, I would say, first of all, the most important thing you should do is trust. No one. I would not trust partners. I would not trust, uh, collaboration of a big company, and I certainly wouldn't trust anyone within an organization with your ip. I really wouldn't. And it's not because there's nefarious, you know, but, uh, these companies don't have an ethos in and of itself. Right. They are just acting for themselves, which I think is totally reasonable. But don't, I mean, we have had companies yet to be named here that will not be named, that have literally tried to steal our IP and create their own companies and they're, you know, a knockout product. Right? We literally have had. Several companies of which we know that have tried to do that. You know, and again, it's nothing personal by individual people or acts, but it's, I would not trust people to do that. Um, you know, I think the mistake you make is, um, you start to trust a big company and then you realize number, I, I think the biggest mistake you, you don't realize is that they're giving you a slow no. Every company, um, especially if you're a surgeon, right? If you're a surgeon, they don't want to upset you, so they're going to give you slow no. For the, for 12, 18, 24 months, right? They're gonna string you along because they don't wanna say no to you upfront. Um, it's important to you recognize that very quickly. I I, if you have a developed product and you bring that to market. And, um, they're stringing you along. It's either one of two things, either they're so inept internally, which often happens. Every company, the big three, every single one of them is inept. Internally, there's just so many different levers and so many people making decisions. It's hard to tell, but number two, it may be that they really could care less about your product. So you, you have to kind of tease that out early on or else you're gonna have, uh, years and years of pain.

Joseph M. Schwab 17:27

Is that the most surprising thing you found on the business side compared to the clinical side, or is there something more surprising?

Charlie DeCook 17:37

I think the most surprising thing is that these companies are so focused on quarterly numbers. They're public companies. They're so focused on their quarterly numbers that they don't have the luxury of. Looking at this from a 5, 7, 10 year timeline, they don't have the luxury of saying, gosh, this is the product that would be really great Five years from now, they just don't. Right? Everyone has to have decisions. I don't, from that CEO down, every single person can no longer make those five year calls anymore. They are lucky if you, if you can get them to see 12 months from now. Let alone five years from now, right. They are dealing quarter to quarter and finances changes every quarter. I mean, I can think of all these pro uh, projects they were involved with within these organizations, and they would kill projects based on the last quarter's numbers. Right. And you, I think that was the most surprising to me is that. Their inability to look long term or even medium term.

Joseph M. Schwab 18:55

Yeah. So I wanna pivot a little bit to talk about the AHF Shark Tank. Which you've talked with us about before.'cause this is a program that really targets kind of these early stage entrepreneurs and specifically authorpreneurs ones who are seeking sort of solutions that are kind of ready to disrupt right. In the operating room. What specific characteristics beyond, say, clinical utility, define an idea that you think is ready to, we'll say, swim with the sharks.

Charlie DeCook 19:28

Yeah. For me, I think the first, second, and third and last decision has to be the right financial model. Um, you have to have a model in which you can't. It's no longer the case where you can have a cool product and one of the big three is gonna buy it and they're gonna take it over from you. That is no longer the case. You have to, because. It's no longer on pull through on implants anymore. This is about can you create a product that other companies are gonna be able to sell? So it is hard for the big three to sell anything other than an implant. Right. Trying to sell a technology or a robot is very hard in this market because of the constriction of price. ASPs are dropping and there's less and less fluff in the system. So as a result of that, your product literally, you're gonna have to be able to sell your product to, um. Hospital organization to a surgeon. Right. That's, it's gonna have to be a legitimate product that surgeons are gonna actually be willing to spend money on. Right. And there's not a lot of products out there, right, right now. Right. We all know, um, at least in the US I know, Joe, you're in Europe now, but in the US you know, it's financially so tight now that, I mean, I look at how much it costs me to, for our bobi or our suction. You know, if, if, if you expect me to buy a technology for my operating room, it better darn well make me smarter, faster, better. It, it's gotta hit all three now. It used to be just one, right? You know, surgical impactions one. Things like joint point or ortho grid, that's another one that's gonna save me time. I'm willing to spend them money to do them, but it, it's gotta prove that pretty effectively, it can't it. We just don't have the money anymore in healthcare to be able to do it any other way. That means the barrier for entry is so much higher now for a product. You have to have something pretty darn innovative in order for one of these companies to purchase it from you.

Joseph M. Schwab 21:44

In terms of the pitch that they give to the sharks, what types of pitches do you see that tend to succeed and what might be some common mistakes that you see?

Charlie DeCook 21:57

Yeah, it. I, I think the best pitches that I've seen so far at Shark Tank include probably a tag team, because inevitably the personality of the surgeon, they may have a great personality, they may be great at presenting, but they literally have no idea about the business model. Right? So for me, I think it's a, a tag team affair where you have the right business people that can talk to the sharks. Because I would say the vast majority of surgeons just do not have the financial backbone or a wherewithal to really play with those sharks. So I think you have to bring your CEO with you. You have to bring the people that are knowledgeable enough to to fight with those sharks because our sharks are getting better every year. Our sharks are being tougher on our. Our applicants and our products. So I think you have to bring someone that really knows the finances, really can make a compelling argument to the sharks other than just a cool product, right? Uh, US surgeons are more interested in the product than we are the financial model oftentimes, and the sharks will just eat them up.

Joseph M. Schwab 23:07

So speaking of the Sharks, how important is it that these are sort of top industry executives within the orthopedic space and. Does that, uh, validation by those sharks help accelerate, uh, sort of global adoption of some of these technologies?

Charlie DeCook 23:26

I gotta tell you, the value to these, um, surgeons that present to the Shark Tank is so huge when I listen to these. Sharks kind of ask questions. Um, it is so valuable the questions they're asking because, uh, inevitably these surgeons or these, uh, entrepreneurs have never really thought about the question they get asked, and it is so valuable. Because they have, they bring years and years of experience. I mean, I think of some of the sharks we've had recently. These guys have literally been in orthopedic med device space for 30 years. The, you know, they just bring so much. They have been pitched so many different products and they've had the. Personal pain of having to take a product, you know, and actually sell it within their company. They've done that so many times that they have just so many great ideas and questions for the sharks. Um, I, I couldn't be happier with their sharks. We've had, and we continue to have, we have super high quality sharks and they're, that brings so much value to the entrepreneur.

Joseph M. Schwab 24:32

Yeah, you mentioned it, it sort of towards the beginning, AI and robotics, but are there other specific areas of innovation? That you hope the AHF Shark Tank will help attract and foster say in the next five to 10 years.

Charlie DeCook 24:48

I was shocked last year that we didn't have more AI type products. So I, I am hoping for more AI type products. Um, you know, when we think about robotics, we think about the entire platform, right? We think about a surgical arm, but there's so much more to robotics than that. You know, if you think about, um. Different companies have looked at, um, pinless navigation. They look at the changing the end effectors, changing the AC actuators. All these things are super important for the robots. So it doesn't have to be an entire robot. It can be one part of a robot, right? It doesn't have to be even a robot That. Does the cuts. It could be a humanoid robot that's, uh, assisting in the operating room. It could be a humanoid robot that's mopping the floors between cases or turnover. I think the other thing that I'd love to see more of is we've totally ignored the logistic nightmare of medical device. By that I mean we have totally. Turn a blind eye to the fact that we're losing so much money, bringing all these implants to every case. I would love to see more and more technologies that are really focused on how we get the implant to that operating room. Um, I think that is pretty critical. And then our last thing I would say is we still don't have a good data solution. We have all these kind of sloppy post-op recovery apps and platforms, but we don't have really a good end-to-end data collection where I can really take actionable data and change how I operate. Um, I think that. I think that to me would be exciting. Um, and there's obviously a thousand others that I haven't thought of. So, um, there's a lot of incredible products out there that we don't know of yet. Um, but we would love to, we would love to see, uh, uh, on Shark Tank.

Joseph M. Schwab 26:41

you've been really generous with your time. I just have two additional questions for you, um, based on your career. If you were to come up with what you think might be the single most important piece of advice you could give to a surgeon currently sitting in their OR who's frustrated with inefficiency and believes they have kind of the next great orthopedic solution, but don't know how to start, what would you tell them?

Charlie DeCook 27:11

Yeah, I would, I would tell them to, um, focus. By that, I mean, you have a good idea now you have to take the next level, and I don't think surgeons realize how much time and effort is required to refining your idea. Um, and to continue to pivot. Continue to iterate on that idea, right? And then once you get, once you're comfortable with your, your idea, then you need a financial model that makes sense. You should not go to any fundraising, spend a dollar until you have a financial model that can make sense, right? Like I said before, you can have great products that are never gonna sell. Right. You have to have the financial model. Once you reach those two hurdles, a great product and a financial model, then you have to find a team that's gonna surround you, right? Because you know very little. I know very little. Everyone knows very little about one particular area. You need to surround yourselves with the right business folks and financial folks that are gonna help you. Achieve this reality. Um, so I would say those three things. Make sure your product is right. Make sure you have a financial model and surround yourself with the right team. I think if you do that, then you can take it to market. Then you can talk to the big three. Then you can talk to medical device companies that may wanna buy it. We try and exit so early in the process like, okay, I've written down a napkin idea here. Do you think you'll buy this from me? Now, you know that that kind of idea I is will never happen. You have to spend literally countless hours pouring over the idea, refining it, and then putting in your own money to do it. Don't, don't, don't, don't go to the big three, two, early in the process.

Joseph M. Schwab 29:01

And I, I just want to close kind of with a single thought from you. So if you could finish this sentence, innovation in orthopedics means, what would you say?

Charlie DeCook 29:12

Innovation orthopedics means doing things differently than we ever have before. Looking at jobs to be done in our operating room or outside the operating room in which we're helping patients and doing it differently and better than we have before.