#63: Diversifying Your Career And Going After The Hard Things w/ Dr. Mark Piehl

In episode 63 of Branch Out, we sit down with Dr. Mark Piehl, Pediatric Intensivist and Innovator, to discuss the creation of his biomedical device, running a company alongside practicing medicine, and the importance of balancing priorities. If it sounds like a lot of work - it is! But is it worth it?

Transcript

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Larson: I'm Larson Hicks, CEO of Sycamore, and welcome to branch out where I chat with healthcare professionals about broad-reaching topics, like their careers in medicine, hobbies, pursuits outside the hospital, and everything in between.

Welcome to sycamores podcast branch out. This is Larson Hicks. I'm the CEO of Sycamore and I've got with me Dr. Mark Piehll today, and I'm excited about our conversation. Thanks for joining us today, and where are you based?

Mark Piehl: I'm in Chapel Hill, North Carolina. My hospital's in Raleigh, a few minutes down the road. And then my company is based in Durham. So I’m here in the triangle, the Research Triangle of North Carolina.

Larson: My wife and I intended to move out there, we lived in the Pacific Northwest and we were planning to move out that direction and we kinda got stuck in Huntsville Alabama, and didn't make it across the country. Let me as an intro, frame up the conversation for anybody who may be listening to the podcast for the first time. Sycamore is a company that's really focused primarily on emergency medicine and hospital medicine. We do some other specialties as we've grown. But our real focus is physician independence, and physician autonomy. We want to see more doctors doing more outside of clinical medicine. Not so that doctors don't do clinical medicine, but really just so that they can do it on their terms. So they can have the kind of walkaway power to be able to say, Hey, I'm going to do it my way, and if you don't like it, then I'll go do it somewhere else. So I think it's a big challenge. It's one of the driving issues behind a lot of physician burnout, just this sense of powerlessness and a sense that, I'm stuck in this gig and there's nothing else I can do. And so we started this podcast because we know tons of brilliant physicians who have branched out from their “nine to five” clinical practice and have done other things on the side. Some of those things have become their main thing, and some of those things remain great side hustles.

But in every case, it seems like it's been a way for them to regain a love for medicine, and get more perspective. So we know that not only are you a pediatric intensivist, but you're also an innovator in healthcare with your own company. And so we're really eager to hear your story in hope that it will be an inspiration to some physicians out there listening to this. 

Mark Piehl: I hope so. Thanks for inviting me. 

Larson: So this is how we like to start the conversation, I love to hear what drew you into medicine in the first place? How'd you end up becoming a physician?

Mark Piehl: Yeah, interestingly, that goes way back to around age five. When I was following my grandfather in rural, Nebraska, around his farm. He was also a country doctor and I just began to admire him, in lots of ways. It's almost unfair in career decision-making, but there was not a time after that point that I didn't think I was going to be a doctor someday. Especially after watching him practice, live, work and innovate in his own ways. That's a true story, and I think I just always had in my head that that's what I would do. interestingly, I also thought I would practice primary care in a rural area and didn't end up in that place, but did end up in medicine.

Larson:  What a cool legacy. How different is medicine today, for better, for worse from the way that your grandfather was practicing when you were a kid?

Mark Piehl: So many ways. I still have this doctor bag that he carried around. I still have handwritten note cards from his patients, which I hope that's HIPAA compliant, that I own those from the forties and fifties.

But, it's interesting, just the questions making me think. I get to practice in a specialty pediatric clinical care, or I get to do a lot of things and be good at a lot of things, but also rely on the expertise of others. And I think of myself sometimes as a Jack of all trades and master of some, I like to try to master some, and I feel like he did that well as well. He delivered babies out in the rural areas and did microsurgeries and provided trauma care and saw people for their hypertension in his office. And just a huge variety of things that attracted me to that style of medicine. And in some ways, I get to still practice that way. 

Larson: I think every physician has a different journey there. But I think most view it as more than a job, really, as a calling. Do you think of it that way? 

Mark Piehl: I do. I feel this is where I belong. I honestly believe it's what God called me to, and that he's given me certain gifts to use and I get to apply them in a way that is a privilege. In meeting people and sometimes their greatest needs and combining science and technical skills and personal relationships in a unique way and a great privilege. 

Larson: There's a lot of things we could get into, but I'd love to just dig a little deeper. He's also your grandfather and the kind of medicine he practiced. How did you find your way into your specialty? Pediatric intensivist?

Mark Piehl: So again, when I went into med school still with the view that I would practice primary care and specialized in the combined. Kind of looked at family medicine and a variety of other things, but chose a combined residency in internal medicine and pediatrics, which would allow me to do much of what he did.

And interestingly just always felt at home and the more critical settings in the ed and the ICU. And I remember back to a couple of nights in the pediatric ICU. Things were going crazy. And I just felt like I like it here. I liked being in the mix of what's going on and taking care of these sick kids and still went out thinking maybe I'll practice for a while in primary care.

I was offered a job before there was such a thing as a hospitalist in both adult medicine and pediatric medicine, which incorporated ICU care as well, the community hospital, I kind of got to do it all and loved that. I still felt like, if I'm going to do this well for the rest of my life, I probably need a better foundation in critical care. And through an interesting turn of events, I was able to both practice and do a fellowship in pediatric critical care at the same time, which is an unusual path. But through some research and publication that I had done prior to that, then with my MPH, I was able to shorten the fellowship a little bit and do it part-time and came out on the other side. I gave up the adult side of my practice, at least in the hospital. I still did some adult practice in a community, a clinic for the homeless non-insured on the adult side, but Steph kept my hand in that, and then practice purely clinical care and inpatient pediatrics, and just loved it and have never looked back. 

Larson: We've already talked a little bit about this but just to put a finer point on it. When you think about the job, the mission, and the purpose of a physician what is the job? What is your mission as a physician?

Mark Piehl: That's a big question. I'm back to what I said earlier about the privilege of being a physician is that I have the opportunity to use some skills that we develop in medicine, and diagnostic skills to figure out what is the problem that is bringing someone in with a life-threatening condition. Then apply the tools we have at hand to diagnose and treat that problem. And at the same time, I think equal parts of importance are the relationships we develop. In the way, we care for that patient, and then pediatrics, in particular, the family. I know there's family care involved in adult medicine, but there's a unique opportunity, particularly with sick kids. The parents are just as much a part of the care. And so explaining to them with the child and the parent what's going on, what we're doing and making that as painless and tolerable of an experience as possible. Then trying to get them through to the other side of resolution of that illness. We have that privilege in a lot in pediatrics, to get through a critical illness and have someone emerge on the other side, sometimes it's as if it never happened. And that's just a great joy to be able to be involved in that kind of care. I created a mission statement for my own practice and professional life, which is, I take care of sick kids, teach others how to do it and think about new ways to do it better. Part of that came out of being involved in innovation and entrepreneurship, but it was always something I thought about, how do we do this better?

Larson: I really don't think enough physicians take the time to sit back and go. What is the mission? What is the purpose? I know you think about it a lot, especially early on in medical school, but I feel like this is part of it, without a vision, the people perish. So there's a need that I think we all have to have an eye on the telos and to have an eye on the end of this thing. When you don't, it's easy to get pulled off into one ditch or another and start to feel like, why am I doing this? So when did you go into the fellowship?

Mark Piehl: I did it over four years, so 2002 to 2006, quite a while ago now.

Larson: And then when did you start your business? It's four ten medicine. Is that right?

Mark Piehl:  Its four ten medical. I believe we were founded in 2013. So good ways into that, after I finished fellowship. I think the idea, the concept, and the need for innovation came during the care of critically ill kids and maybe one in particular who bled to death after all severe injury from NBC that we flew into our hospital. And I thought, maybe this shouldn't happen and is there some better way we can care for this kind of kid? So I think the seeds that were planted early, the actual company started a little less than normal, around eight years ago.

Larson: So tell us about it. You've alluded to it, but give us a little more detail. What's 410 do  and what's the focus?,

Mark Piehl: The big kind of condition or treating is shock and it is a commonly encountered condition in many areas of medicine. Basically it is this state where you're simply not getting enough blood, oxygen and nutrients to round the body, brain, heart, kidneys, and lungs Common causes of this are hemorrhage, so trauma and bleeding from obstetrics. And then sepsis, where you have bacteria or inflammatory things in the bloodstream that reduce your blood pressure and impair your delivery of blood and oxygen to the brain and other organs. And then other things like allergic reactions and anaphylaxis, like a peanut allergy. This fascinating concept of MISC that you might've heard of in post-COVID kids, so kids aren't dying in huge numbers of COVID, but they're getting complications and MISC is one. It can lead to shock diligent, and an inflammatory state in the body where the heart and the blood vessels just aren't working adequately to supply blood to the vital organs. And in many of those cases, we try to fix that condition initially by giving some amount of fluid, blood, or plasma to the patient to restore that blood pressure and profusion to the body. And we have a ton of different ways that is accomplished in various clinical settings, whether it's and the ambulance or helicopter or ER, ICU. Or even in Afghanistan after an IED blast, there are a lot of patients who need quick resuscitation, meaning we've got to stop their bleeding, and  have got to try to turn off the thing that started this problem, whether it's injury or illness or Sepsis. Then we've got to get that blood pressure fixed and blood or fluid back into them. And I felt that from that one child onward, that the process flowed poorly, we have some tools we have Ivy pumps, we have bags of fluid that we can squeeze. We also have big mechanical things in the ER called rapid infusers. All of which are designed to fix that situation, but many don't work as advertised in the moment you need it most acutely. And in that one child, I mentioned in particular, we were simply trying to pull up blood and syringes and infuse it into her as fast as we could. And we just didn't have the man and woman power and ivy access and tools to do it well. And She died of hemorrhagic shock, which is one of the leading causes of death in trauma patients. So the wheels began turning that at that time, Sepsis was becoming more of a talked about topic and early resuscitation with fluid for Sepsis was on a lot of people's radar. We were trying to up our game a little bit in the hospital, using various techniques to get fluid into kids quickly and the right amount within the right time. I just felt I did a lot of work in medical simulation, where we would teach residents, students, docs, nurses and paramedics in a simulated environment. Here's the emergency that you need to deal with. Let's go, let's do it in a life-like mannequin and we observed over and over that the task of fluid and resuscitation  blood plasma was not something that people did well or had the tools to do about. And so the idea of a handheld more precise, more intuitive, rapid infuser that could fix the problem quickly wherever you were, whether it was in the ER, the ambulance or ICU. It would be something I'd love, to think about creating. And over the next many years we throw a pretty complex process, prototyped it out and thankfully it's out and in use and in working so many years later. Yeah.

Larson: So it's a device and it's essentially a it's a Essentially a pump a handheld pump.

And is it using, is it battery powered or is it using all manual?

Mark Piehl: Yep. It's all manual. The beauty of it is that it's all manual. I think there's some desire in some clinical settings that we have an automated version, which is on our on our to-do list and in the works.

But at the moment it's all manual and there's a beauty to that, which is. You have to decide, I want our assessment, this patient, I'm going to do it. And I'm going to watch the response. And that's really, one of the keys is more like a dose response effect. I can deliver a matter of fluid, whether it's 50 mils to a baby or 500, 200 adult very quickly and watch is this improving their clinical, including their physiology.

And you can see it immediately. That's so cool. And maybe you were getting. The life Lexi. Deller how it works. It's like a cock gun. If you can imagine a caulk gun where instead of a barrel talk that you would insert it in the guy, I just spike a bag of fluid blood or plasma. And with each squeeze of the handle, I deliver amount of fluid.

And then I release in it. The syringe fills again, and I can then re repetitively do that as much, or as little as I need to based on the patient's clinical condition. Yeah, it's all manual, all intuitive, all all a fairly simple to use.

Larson: Okay. So you're a physician, you see this problem you have a vision for what this, let's create a cock gun kind of thing, and, but how do you, we're talking about a product, we're talking about industrial design here. How. How did you go about that? Did you go to the garage and grab a cock gun and start sticking bags in there? How did what was that process like for you?

There

Mark Piehl: was actually a garage component. Believe it or not, where I fiddled around with a lot of different things. And I'll preface this by saying if I knew how hard it was to get to where we are now, I'm not sure I would have done it. So just fair warning to everyone. Listen. It's been total privilege and worth it.

And yeah it's not easy. So the way it actually came about, I was serving in a number of administrative roles at our hospital at the time, in addition to practicing. And didn't really have time to think about doing something different and was approach where I'm at wake med and Raleigh, North Carolina, and we're next to NC state, which is a well-known engineering school.

And. And approached almost yearly by the biomedical engineering department for mentors, for their students to help develop new concepts. And for many years I just said, I don't have time. Sorry, I'd love to, but I don't have time. And finally I said, you know what? I got this idea in my mind. And why don't we see if a group of engineering students and I together could make a concept.

And they agreed and I agreed and we I became the mentor for the senior design team. And in our simulation center, we had weekly meetings and we talked about the need and the possible design ideas and prototype out a few things and actual the first, actually the first a 3d printed prototype semi-functional prototype came out of that work with a group of senior college students in engineering.

And we Made something that looked like it might work and sat on that for a while. They went their separate ways. I stayed engaged in all of the stuff I was doing and are in the hospital with practice and administration and a lot of work with our transport team, just variety of things. And happened to meet a now good friend.

And my co-founder on a additionally, a ski trip with a bunch of guys and he had. The biomedical device world, and now is in more Metro capital. And I presented the idea and he's man, that's good. We should start a company. Wow. Jokingly. And we sat on that idea for the year and then decided that, Hey, we either need to make this work or not.

And so we, we decided to do it and take our concept. This is all bootstrapped. Initially with our own funding, we made a more work a more definitive prototype that actually worked and decided this looks like it could happen and then write a story around the funding and With about a year and a half and a million dollars and three guys we in the help of many other people, we with our lead engineer and two co-founders, we got from concept to our first FDA clearance and about a year and half and launched from there.

So it was a fascinating story. That then has just become more fascinating, more complex from then, but yeah, it was an annex. I was an, I'm an accidental entrepreneur. I didn't think I'd ever get to this point and maybe I didn't even want to, but it fit into it, fit in the, excuse me.

Let me start over. It fit into the general concept of improving. Thinking about better ways of improving care for sick kids. And yeah, it felt like we were led to do it. And so we moved forward. Yeah, it was, that was a fun, interesting experience, which then caused me to need to drop something in life.

I have a curse of trying to want to take on too many things. So I moved out administrative roles, kept my practice role and then moved to. Leading the company in those early years wow.

Larson: So was there a, was there any fine print with with the the university when it came to the tech transfer or, licensed here?

Was it, was there any, are there any strings attached there?

Mark Piehl: Not that I knew of at the time, but there were so a fair warning again. Thankfully my hospital, large community hospital. We're a teaching site for a couple of universities nearby. Do, can you see, we did not. At that time habitat transfer policy, they were happy to work with me, but the university and I had not probably done enough diligence on what would happen if this thing actually became a product.

And so there was a fair amount of complexity on the IP or the patent language and who owned. Yeah we were able to resolve that. That's another hour long podcast for you someday, if you really want to know how that went. But we ended up in good relationships all around and the company owns the patents in the hospital and as part of the company and yeah, so that all worked out beautifully in the end, but it was very difficult.

And so one trick is, as you think about new innovation, the diligence around how you get your patent language down. Who owns the intellectual property is a complex thing that I walked into. It was one of the many minefields that we walked into before we understood the process very well, to be totally honest.

Larson: Yeah. One of the things, you've already said this and I think it's an important point to make or I guess maybe a question to ask. But it seems to me that you said this earlier, that if you'd known how complex it was going to be, you might not have been up for it. And it seems to me that physicians have.

Are really good at school. They're really good at learning. They're really good at education. And so there's this it seems like there's almost a temptation Maybe not analysis paralysis, but it's the sense that if I'm going to do it, I need to really, I need to really have done all the diligence I could possibly do ahead of time.

And at least in my experience in business, it sounds like in yours as well. You can't really. You kinda just have to get in there and cause there's 800 different things you could study and learn about when it comes to business and finance and license, intellectual property, et cetera.

You just, you gotta basically just be ready to go learn whatever the next problem in front of you requires you to learn.

Mark Piehl: Yeah, that's true. And we went into this with a lot of gaps in knowledge, for sure. If you knew them all, like I said, he probably wouldn't go, you probably wouldn't do it in the first place.

There's a lot of risks. Creating a medical device involves a lot of risk and thankfully I've been surrounded with people who are experts in many. My co-founder is in the business space, Luke. And my first guy we hired who was our COO and our lead engineer day. Yeah. He knew med device design and patenting and all that.

So just finding the right people to, we all, we, all we talk about and part of the company name has to do with concept of each using our own gifts and skills together for a common purpose and for the benefit of others, which I couldn't have done it without. So expertise that I just don't possess.

And one thing I had the idea about what needed to happen, and then I needed people to help me make that happen. But interestingly, that, that same concept leads to one of the barriers in adoption of our product, which is in well over a hundred hospitals and EMS agencies and helicopters and other places.

Well used and well loved in many hospitals and clinical settings, but there, we continue to face barriers to innovation and to new concepts. And I think that same principle you've articulated, which is I need more data before I need more. And I'm not sure. I believe that this would work, that people are generally reluctant to adopt innovation.

And that's been a, that's been one of the hardest parts of this whole process is thinking, oh my colleagues, we all think alike. And. We all want to make things better ensure that people are going to love a new concept and that's not always true in fact. Yeah, totally. It may be true a minority of the time.

Yeah. Good.

Larson: That's a great, that's a great point. And I think He, physicians, God bless them, have this naive optimism a lot. I talked to a lot of them, and our founder of our business as a physician. And he's got a lot of that. He'll be the first to admit it too, but it's a wonderful thing, but it's also, there's this sense that, there's a problem.

I've seen it. I've experienced it firsthand. I'm going to solve it. And then. People gotta pay me for it. It's gonna be great. Exactly. Yeah.

Mark Piehl: And again, one more warning. Don't go into it with that idea, right? I'm doing this for the love of doing it and I hope it's a commercial success, a big one eventually.

But it can't be your primary motivation. I think good ideas and good innovation will you'll in general commercial success, but you can't make that your goal for the entrepreneurship path. I don't know.

Larson: And there's also, I think the other piece to that too. You're right. And I think the other piece is that there, there is a whole other set of skills and techniques and disciplines, that around discovering product market fit and, Positioning your product and the, in the marketplace and doing the diligence that you need to be able to take a product successfully to market.

And that's I think that's the overlooked part. It's I'll just build it. And then we'll just have a shingle on people, just show up with their money and it'll be great.

Mark Piehl: It's not easy. I know.

Larson: I looked up as you were talking, I looked up Luke and and interestingly he Sovereign's capital just invested in in the company, a man at my church owns here and hunt outside of Huntsville and actually my little brother works there.

So they're yeah, they're talking about my brother, my little brother's talking about Sovereign's capital all the time.

Mark Piehl: Those co-founders are good friends. And interestingly, those guys just watching them, I was always fascinated with the idea that you could take a concept of a company out of it that does something useful and interesting and employs people and benefits people.

And I always thought I'll never be able to do that. I admire them from afar and then learned, I think in many ways. And I was inspired by them and thinking, okay, in medicine, we can do that too. Yep. And improve. For patients that way, and it's not easy, but it's a worthy path and I've appreciated the partnership of sovereigns and Luke and Henry and all the guys, they had women there that are a part of that.

Cool.

Larson: Yeah the whole capital, you talked about one of the landmines being intellectual property. I think the other big landmine for entrepreneurs is funding and how you go about doing that. And I think. Again, another area of naivete for all entrepreneurs is is the idea that people will just give you money to and leave you alone.

Like they'll let you do your thing. And it's there's usually There's usually strings attached, right? There's pretty significant strengths. They're going to protect their investment. And you need to really vet your investors.

Mark Piehl: Right. Yeah. And we've been blessed with a great partners and investors you do, and you need to seek capital where you can find it.

And. Yeah, it does come with necessary and important strings, which is we're going to invest in your concept and you're going to produce results through it. And those results are case clinical excellence and clinical improvement, and then a return on investment. And we it's right and good for us to be good stewards of that capital.

We need it to. When you can't do this. It's hard to find a company from start to finish with grant funding. You just, there's some folks that have done that and in certain areas, maybe drug research and that kind of thing, it can work. But for the, our concept, we needed people to make a bet on us and say, I believe what you're saying.

It sounds good. You here's the capital to go do it. And we've had really. Awesome relationships with a good number of investors, some venture capital, some private folks some friends, some family members, although that's more of a minority and angel groups. And it's been, that's been a fascinating, interesting experience to learn to that world.

And so my sovereigns is one had her address here in RTP is. One of our investors and important partners, and then they help us lead the company. We work tightly with them on strategic decisions and all that. It's not easy though, because we rightly need to return that capital with with with a premium.

And I think, like I said, a good innovation, ultimately we'll do that ideally. And so that's what we're working towards.

Larson: So your, so what's your, what's your balance now or what's the mix and in terms of your clinical life and your your role as CEO.

Mark Piehl: So I'm just to be clear, I'm not CEO.

So I started out as CEO early and then quickly realized like, that was not my best role and A real CEO, Kyle Shenay news, Stanford, MBA trained, awesome guys been in health med tech for a long time and really knew what he was doing. And this has really helped us grow with his unique gifts, the company to where we are now.

So thankfully I serve as the CMO and kind of CEO. We probably have about 25 people now. That's a big team. It's small company, but it's a big team to lead and Cal all those stats about. And I'm washing now. I'm blanking on the question.

Larson: Oh just kinda what's your kind of mix of what's it look like for you now?

Yeah,

Mark Piehl: I'm technically a halftime with the company and halftime with the hospital. I think it kinda ends up being way more than 50% at both fashion company. Thankfully, they integrate in many ways white men as the kind of that origin hospital, this concept that we use it there, some more research is happening there.

The the hospital itself as an investor, which we're thankful for. And so I practice in the ICU and EMS medical direction for our critical care transport to. Technically half of my time, a little bit more. And then doing research fundraising interacting with customers, speaking at a variety of conferences, I'll trauma, sepsis innovation, you name it all over the country in a virtual leader.

Live a lot of the time working with our clinical team. So most of our sales folks are nurses and paramedics. We have a great time working together on introducing the life load concept, train. Hospitals and agencies, and then following up with them subsequently and ideally also conducting research at many of our customers so that we can publish some of the great experience they're having.

So yeah, I do technically 50 50, but being part of a startup is going to not make that an all consuming thing. So it's a.

Larson: I think, and I think the, that segues into the next question, which I'd like to come back to the topic of burnout. Cause it, cause I think one of the one of the assumptions, at least to the lay person about burnout as well, it's just because they're working too hard.

It seems like you're working. Maybe harder than most with the kind of pulling double duty do you feel like that's leading you to burn out or do you feel like it's actually working the other way around?

Mark Piehl: It's such a good question. I'd say in general, it's the other way around. I think there's definitely a risk of burnout at the pace I'm running.

Yeah. And that's a conversation. My wife and I have a lot and partners might have a lot it's. It's probably not a long-term sustainable pace, but it's also a thrilling, exciting and rewarding one. And certainly I've had to make some choices. There's things I'm not doing. For example, you mentioned your church at my church or elsewhere in our community.

I've been involved in a lot of things that I just have had debt put aside to focus on clinical practice in the company and keeping my family a priority. But I think in terms of medicine, I actually find myself enjoying clinical practice even more. And I'm almost 55 and still look forward to going in at night and spending the night in the ICU.

And even though that wears me down, yeah. It was a joy in it, and it's not going to be everyone's story, but I think there's in this work I've had. Probably a better I, because I've had to become more of an expert in some of the spaces that we're active in as a company, trauma, sepsis critical care management.

And it's been fun to teach in those topics, published, be part of grants with the department of defense. Speaking on these topics is I think in some ways helped me become a better physician because I have had to have more clarity on what is this. What is it we're driving toward and what are we trying to fix and understanding that the medicine and the physiology better, I think has probably brought more enjoyment of practicing it as well.

And I also get the privilege of seeing our product in action. I can go down to the ER and there's the lights low and use. And I think, wow, that's neat that I got to have a role in designing.

Larson: So yeah. I think you said this Very well in that answer. But but I think we, since the industrial revolution, there's been this kind of slide towards greater and greater specialization, and you took people like. Your grandfather, who ran farms, which were very, it was a very, diverse kind of environment. You're doing lots of different things from mending fences to fixing tractors, to. Harvesting and and caring for animals. And then he's also obviously a physician.

You took people like that and put them in factories, pulling levers, and and healthcare seemed to move that direction. And I think there's a number of factors that play into why it's become more and more specialized, but it certainly has. And so I think it's that specialization For a lot of people the monotony of this is all I know how to do and feeling trapped and also just, it's, there's a lot of fatigue that sets in when you're just doing the same thing, I think that's

Mark Piehl: right.

And yeah, I think there's opportunity whether, not everyone has to start a company to, to diversify in medicine. There's a lot of other ways I find teaching to be a refresh. Part of my practice and that keeps it interesting. And I learned from the learners. And so we teach residents in lot of specialties on daily basis.

And then being in part of just quality improvement initiatives at your hospital and working with our transport team, I love them and love the, just the they're refreshing as well. Just they're hungry. Improving care for the kids who transport. And I get to have my hand in a variety of things.

And I think that prevents the burnout of in some ways of just doing the same thing every day. I think the specialty I'm in has also quite, has quite a bit of variety. And so if you're in something that's not, that does not have as much of that and maybe seeking other opportunities for qui or administrative roles.

Education opportunities, I think can help diversify and keep you as excited about your clinical practices as he wants work. Yeah, I agree with you on that and great.

Larson: What's your, you've mentioned your wife a couple of times. What's your wife's role in all of

Mark Piehl: this? That's an interesting man, I couldn't have done it without her.

We actually prayed together that whether we should start this company and that was an important part of our initial. Towards it. And she's been behind me and helped me and encouraged me and put up with me throughout. And I think in some ways she's had to put some professional things in the background to allow this to happen.

I don't want to undressed shouldn't underestimate the cost potentially to those around you at the same time. It's, it's, God's grace, but we've had three kids that we've raised and last one is. Our home. And and they've seen this process play out and our interactions around it during the stressful times.

And I think it's been a neat experience and what I'm thankful for. So she, I, I couldn't do without her.

Larson: It's it's actually a decent piggyback on the last question because I, cause I do think, the other thing that happened with the industrial revolution is his dad typically left the house, left the home, the homestead and went off to a factory and our lives as families kinda got pulled apart.

And I think one of the interesting things that's happened really since COVID and a lot of ways. People have come back home, and are working remotely and they're in the home and more people are homeschooling and in a weird way, it's been this experiment for a lot of people, this huge experiment for what's life like together, and I think a lot of people are realizing, Hey, this is pretty cool. And and I certainly, I certainly think th the farm, and I'm not like a. I'm not like a romantic, pining for going back to the agrarian days. But I think there was something really important that was lost there.

This idea of the household, a productive household that everybody in the family's contributing to, it's the family's work. We've really lost that. And so I, one of the cool things I think about entrepreneurship, especially is that you have an opportunity. As a family as a couple more often than not to really work on it together, and it, it really takes both parties, I think to really do it. That's a good point.

Mark Piehl: I, it, and COVID has been a time where we were reunited as a family, more kids were home. I was home more. I think the business, I think if I was practicing only to be fair, I would have probably more time at home.

Given that, just the nature of the work of my. Yeah. And so I'm working more hours, but a good bit of it's been here, the desk behind me, if you're seeing my screen Larson is my daughter's desk. And sometimes we'll be here together. She's doing homework, I'm working on stuck for four 10, and we are around.

And I do have flex some flexibility. I travel a lot. That's something that has to be carefully managed because it's not healthy to be gone all the time, but. A lot of my work thankfully gets to home and I can have a walk with my wife and the dog in the morning and we can work up here in my office a lot of the time.

And yeah it's been a nice benefit of this this entrepreneurial venture and incidentally of COVID, as you mentioned, we've had a little more time to get. Might have otherwise. Yeah,

Larson: that's cool. My my son's sitting here in the office working with me as well. Yeah. But no, it's a well, and I think one of the things that we've lost too, is this, I think the idea of like balance where there's gotta be a certain amount of the time you spent with your.

Has to be just recreation, which is which, yeah it's, my favorite memories as a child were working on cars with my dad, working on cars or working out at the orchard with my grandpa. Those are truly my absolute favorite, most cherished memories. And so it, wasn't the the expensive trips or the, or the, just the recreation.

Mark Piehl: Yeah, actually. Yeah. And then the kids follow me around the hospital, some, and what's involved in the clinic that we started and been involved every step of the way in this, in the company. So it's been fun for them to be a part of it. I'm glad they weren't little, when I, when this happened, they were all teenagers, so a little more independent and that facilitates.

Yeah. Some of the time that I was able to spend with the company, but yeah, I agree if we haven't having a presence, having them understand what I'm doing has been a enjoy.

Larson: That's cool. We're coming up on an hour. I have to, the one thing I haven't mentioned yet, but I really want to ask about, cause it, it made my skin crawl.

I watched the video of you drilling into your leg. What was that all about? I showed it to my wife and she just cringed. And w just, w I thought she was going to lose her lunch. I'm

Mark Piehl: not, I am not on Instagram, but apparently if you go to Savage paramedics, there's half a million views of that video.

If you want to look it up. Fair warning though, about the other stuff they show on that Instagram site, there's real stuff. But so one of the problems in that child, I mentioned you years ago, who bled to death is we didn't have. So if someone's dying and you need to get blood or fluid into them, ideally they're an IB.

And then you'd be able to give it through that device. And at that time we did not yet have the invention called the easy IO, which was a drill that you had is barbaric, as it sounds, you can drill a needle into someone's leg or arm, and that becomes like an IV. You can actually put blood or fluid right into the.

Wow. And yet it was slowly. So one of the concepts with my original devices on was we need something that can allow you to get blood or fluid through that bone quickly when the patient needs it. And amazingly, it doesn't really hurt to put the needle in. It seems awful, but what hurts is infusing it under pressure into the bone marrow that hurts really bad.

And what I was showing in that video, I want to reduce. Fear about using iOS incredible situations because we can't get an IB and you spend 40 minutes getting one patient's likely going to die. But if you can put an IO in and get them blood medicine fluid in, you may improve their outcome.

And so I just decided I'm going to go do it. I'm going to, I'm going to drill one into my own leg and show people. It doesn't hurt that bad. It hurts. You'll see me in the video fringe a little bit. It hurts, but what hurts is infusing under pressure. And if you use any kind of device. Developed a pressure.

It really hurts. And I learned this firsthand and one of my child, patients who I was unresponsive until we began infusing blood into their leg, and then they woke up and I realized, oh, this hurts a lot. So I was just basically teaching how to provide anesthesia, the right type of anesthesia with anesthetic meds in the bone marrow to make that process tolerable in a semi awake patient.

That was the point of the video. It's been fun to show folks that it's possible to do, and you can do it to yourself and you can survive through that. Wow. But more importantly, that this is a technique that is improving our recitation and you should ever just, and I was having to lower people.

People's barriers to wanting to use it in critical situations. Wow.

Larson: So cool. Yeah. I love I love the willingness to. To go under the knife. So to speak,

Mark Piehl: just to understand if you read some of the feedback you'll have a good time reading some of the feedback there on YouTube and Instagram.

When people thought about most of us positive, there was a few good people that to sit out it's crazy, but yeah,

Larson: that's awesome. It was a little crazy but I think it's, I think it's great and it definitely makes your point. You're like, wow, okay. That guy just did it and it can't be that bad.

Right. This has been a ton of fun and I feel like there's a lot of, there's a lot more things we could probably dive into but I love what you're doing and I think it's a. It's such a cool story and exciting to see, a physician who just had an idea and walked down the path and here you are with, 25 or so employees and a growing company and and.

And, you're still practicing medicine, I think it's great. And I hope that other physicians hear this and maybe it'll add a little bit of a realism, to those dreams, but also some inspiration to,

Mark Piehl: and I have both have, I'm thankful that you're willing to have me on and I hope.

How someone else.

Larson: Yeah, I'm sure it will. This has been a lot of fun. And thanks again for coming on the show. Anything. So if people want to check you out or check out your your company, where would you point people?

Mark Piehl: So for 10 medical, 4, 1 0 medical.com. You can see everything about life led device, a little bit of our bio's and we have a lot of literature and videos and stuff there.

So you can start over. And that's yeah that's a good source. Awesome.

Larson: And and where was the video? I'm sure some people are going to want to go on

Mark Piehl: you, if you just Google Dr. Drills, bio, something like that. You'll find me. It's on a, there's a doc in Alabama named Larry Malick who has a full site of live clinical videos, which is awesome.

And he was kind enough to put our IO, my IO video up. And then it's on Savage paramedics, which is an Instagram site aside as well, either this place and you can find it. Cool. I would advise the YouTube version. So you don't have to see all the other chairman.

Larson: Yeah. Yeah. Cool. Thanks again. This was a lot of fun, all the best.