The “Beyond the Practice” Series has been created to give you an insight and advantage into the professional side of anesthesia through interviews conducted with leaders in the industry. In this interview, Trevor Gibbs, an anesthesiologist and founder of Anestand shares with you his story and advice for taking that great idea and bringing it to the market.
BagMask: Let’s start at the beginning. When and where were you when you came up with the idea for the Anestand?
Trevor: The idea struck me several years ago while I was doing a rapid sequence induction on a morbidly obese patient that was not NPO. I set the supplies on the patient’s chest, like we always do, and started to induce. That’s when everything went sideways. First, my sux rolled off the patient and onto the floor. The nurse was holding cricoid and I reached down to grab it. At this point, the SATs are already starting to drop. I go to get my IV port, which is now underneath the wheel of the IV pole, and as I’m pulling on that the SATs continue to plummet. I’m getting frustrated and think there has to be a better way. That disaster of an episode was the inspiration.
I started to think of what I would want to hold my supplies. Where would I want that to be located? How would it work in our workflow? Could it hold my IV or suction tubing since they are always falling on the ground?
From these questions, I started to brainstorm ideas and the first one was a small Mayo stand that would slide under the mattress. But what if I went Trendelenburg, then everything would just slide off. I also wanted it to be able to help me if I was doing something on the arm board like placing an IV or A-line. So how about putting a clamp on it to hold the tray out by where I was working and level? I went through this whole mental exercise of making this product that could help me and then I just sat on the idea because I didn’t know how to take that first step.
BagMask: What was it that took you from just an idea to actually taking that first step of making prototype Anestand?
Trevor: Every once in awhile I would think about it, but I didn’t it do anything until I had another similar rapid sequence induction and said “That’s it. I don’t know how I’m going to do it, but I’m going to make this stand.” It wasn’t even an entrepreneurial venture, I just wanted one for me.
Initially, I looked to see if there was a place I could order one. I found there was no anesthesia specific stand that fits in our workspace and workflow. I thought, “Well then, let me look into how I could make one.”
Finding where to start can be difficult, but I discovered an organization called SCORE, which is a society of retired executives and entrepreneurs. I looked up a local chapter and read over the list of mentors trying to find who would be a good match. Ultimately, I decided on a mentor who had gotten a patent, started a company and then sold it. We connected and part of the process was to create a presentation for him to review.
I went to work creating the presentation. I took pictures of the table, the circuitry, anything that had to do with the workflow and wrote information about the problem and the solution to address it. Then it was time to present it and at the end of the presentation he said, “I see a lot of things come across my table, but I think this has some legs.”
Shortly after that we met with a patent attorney and, by the end of the week, I was at a prototyping lab discussing the product with a project manager.
BagMask: That all happened very quickly.
Trevor: Once I met the right contact, within a week we were off and running. This was in 2016.
BagMask: What I am curious about is what the patent process entails?
Trevor: Safeguarding intellectual property can be expensive, but there are several ways to approach it.
The first thing I did was submit a provisional patent. It’s a hundred dollars to file it and doesn’t have all the details of your full patent. However, it allows you to put the idea down on a piece of paper, submit it and then you have one year from that date to file your full patent. As long as you do it within one year, the date your provisional patent was accepted now becomes the official filing date for the patent.
The year time frame gives you time to explore the idea to make sure it’s going to be worth your while to invest in it and, most importantly, protect it during this exploration phase. Knowing about the provisional patent was a big help. After talking with my lawyer, we didn’t file the provisional patent until my first prototype was ready so we would have a full year before committing to going forward.
Having the provisional patent allowed me to show the prototype without fear of someone stealing my idea. And having that year allowed me to validate that I was onto something before investing time and money into the patent. The provisional patent was one of the best things I’ve learned about early on.
Bagmask: You mentioned it can be expensive to file a patent. Did you bring on investors early on or was it just you working on it during spare time and self-funding the project?
Trevor: The first two years, it was self-funding and a lot of hustle. When it came to the patent, I could have had the lawyer write up the needed information but that would have gotten expensive very quickly so I wrote everything that I could. The lawyer would say, “We need the background information,” or “Describe the product, you write and I will edit.” So I wrote as much as possible and it saved money.
In the end, it still cost around $23,000 for the U.S patent and then for Europe and Canada it will cost another $10,000.
It’s not cheap securing the intellectual property. However, there are ways to do it so you are not paying everything out of pocket. Once you have the provisional patent, you can bring it to venture capitalists or angel investors. Another option is to bring it to medical device manufacturers.
One of the interesting parts I discovered early on was when approaching medical device manufacturers they will not look at a presentation for a new medical device that is not patented. That’s because they do not want to be accused of stealing your idea if they are working on something similar when you present it to them. So once again, having the provisional patent is handy.
Now there are benefits and drawbacks to bringing in these types of investors. They can help fund some of your expenses, but you are going to give up some control or equity in the company.
BagMask: How much equity would you have to give up?
Trevor: I have a friend from medical school that was visiting and I shared with him what I had been working on with Anestand. He was kind enough to offer an introduction to the Chief Medical Officer of a small growing medical device company that was looking for new products. The company did their due diligence on Anestand and, in the end, they wanted it.
It was great! However, it wasn’t going to leave me with much. So, I turned them down. What you will find if you work with any of the big companies is you are offered less than 10% ownership or royalty.
BagMask: So did you ever bring on any investors?
Trevor: I was working full-time and when I wasn’t in the OR I was putting a lot of time, effort and money into the project, but I knew I couldn’t do it all by myself. I still had to deal with FDA approval, marketing, sales, accounting and creating a website.
I approached family and some of the partners in my practice who expressed interest in investing, but I wasn’t just looking for money. I wanted active investors. People who could help me attend to parts of the business I just didn’t have time to address.
They have been an incredible help. I am grateful to have people who believe in Anestand and can bring their own hard work and ingenuity to create a successful company.
This process has really given me a lot of experience with lawyers. Many steps required legal help and that was something I was not very familiar with. Employment contracts, valuation of the company, shareholder agreements, registering a trademark, selling equity and registering that with the SEC were just a few things I needed a lawyer for. I think if you have this expectation at the start it will prepare you for the cost and work it takes.
BagMask: Having a strong team surrounding you helps with the bumps that come along with any business. What have been some of the difficulties with launching Anestand?
Trevor: The most difficult part was finding the right person to answer a problem. Initially, it was finding that first person to help make those introductions to contacts to get the process moving forward from just an idea.
Then, how to handle the FDA approval. Of course you start with a Google search and find all these companies that will charge $60,000 to get you through the process. That was a route that just wasn’t feasible.
I found a freelance person that had over 30 years of experience dealing with FDA. He offered a reasonable hourly rate and the expertise that comes with navigating the process has been perfect. Again finding that right person to answer a question can be difficult, but when you do, things start to go in the right direction.
Then, the other difficulty we faced was the constant revisions to the design or the process to manufacture the Anestand. It took us a year to create a mold that gave us the exact design. You would think it would be easy, but when plastic comes out of a mold it shrinks and not all parts of the design shrink the same. So, there was constant tweaking to get it right.
There was also a lot of tweaking with the clamp. Taking into consideration the different bed sizes, not just those in the U.S. but also in Europe, was a process to find one clamp that worked on all of them. After many revisions and set backs we were able to find a working design.
BagMask: It’s easy to get frustrated and give up. What kept you going?
Trevor: There were two things. First, I wanted to create the stand to help make my practice of anesthesia safer. Then, there was the vision of having something outside of anesthesia that was very enticing and I really wanted that experience. When I got frustrated I thought, “Am I going to sit here and just continue to do the exact same thing I’ve always done or am I going to really work towards something different?” So it was the drive to experience entrepreneurship and to help my clinical practice.
BagMask: What would you say has been the most fun part of this journey that you’ve been on developing Anestand?
Trevor: Solving all the problems that come a long way. There is always something. How am I going to get through the FDA? The FDA is taken care of, so now how are we going to get sales? What’s the best way? How are we going to pack it in a cost-effective way? Are we going to store the finished products in a warehouse and how are we going to distribute it?
You have this problem and you think “Oh man, it’s going to be hard,” and then you start working on a solution. Sometimes you come up with an answer quickly and other times it’s months. But when you come up with the solution, it’s just so rewarding to solve a problem.
BagMask: That sounds like a typical anesthesia provider, solving problems. Last question. What’s your hope for all those anesthesia entrepreneurs out there who have an idea in their head for a great product or business?
Trevor: I hope that they take that first step to explore their ideas. Rather than sitting there and thinking that it would be a cool idea and not doing anything, look into if it’s feasible.
Even if you discover it’s not worthwhile pursuing at least you got past the point most people never do. It’s better than being left wondering, “Could I have done it?”
I want them to understand those first couple steps: who to talk to, how to protect the idea and how to fund it. Unfortunately, there’s not a good amount of people reach out to, but I’d be happy to point them in the right direction with no strings attached. I have been in their shoes and know I wouldn’t be here without people to help me.