Debbie Lin Teodorescu, MD, MEng - Founder of SurgiBox
Mission: To ensure safe surgery for patients and providers at any time or place it is needed.
How would you describe your product? And how would you say your product came to be? SurgiBox is an operating room in a backpack system that’s trying to make surgery safer and more efficient for patients and providers in areas that may not have the necessary resources available. The idea for SurgiBox came about when I was in my first year of medical school. One of my anatomy professors talked about surgical missions in Haiti, Mali, and some other places. Even though we have made such immensely cool advancements in medical technology, we still don’t have any good ways to keep flies and debris out of patients when we’re working outside in a makeshift, non-sterile surgical field, so we started brainstorming about how to create something that would allow providers to do that more feasibly.
How did you go from that idea to creating this company? We initially were just trying to build a glovebox-like system for surgery that a few of us could use. In the next few years, global surgery became a much higher priority in that things are scaling up and people are realizing that there are still big gaps in the infrastructure needed to provide safe surgery in certain parts of the world. There was a greater awareness amongst myself, my team, and other people in the community that realized SurgiBox could play a big role in filling that gap. One of the surgeons we spoke to said “So you guys are like cell phones, right? You’re in some parts of the world where you’re just leapfrogging over the areas that don’t have landlines.”
Could you talk a little bit about your role when you were getting the company started, how it’s evolved, and what you do now? SurgiBox is currently in the interesting position of being a company with a nonprofit R&D-focused arm that’s still the center of a big collaboration. Right now, I’m the president of the board of the company as well as the founder of the company, but equally as important, I’m still the project lead so I can still have an active role in the R&D side. On the other hand, I also put in dedicated time to clinical work as well. For the day-to-day running of the company, we have the rest of the team helping lead and manage the company, which allows me to work a lot more on the bigger picture side of things. It’s the best of all worlds I think.
My role has evolved a great deal. I think I always considered R&D as part of it, but at the same time, when you’re trying to do something that doesn’t exist yet, a big part of my role has been to validate the need and the pain points that exist in the market. It’s a lot of doing a little bit of everything myself. It also meshes well with my goals in that along the way, we ended up building a huge, unprecedented collaboration with multiple universities and organizations both nationally and internationally. All these groups kind of ended up rolling into one in order to make this vision come through.
How have you been able to balance your clinical responsibilities with your entrepreneurial responsibilities? Is there anything you do practically to help you with that balance? By having the most awesome team possible! They understand that there will be times that will be easy and times that will be less easy. From a practical standpoint for a given year, there will be a number of months that are a lot more flexible than others. But even within a given month that may not be very flexible for rotation services, there will be hours that I’m not at work or working on clinical activities that I can dedicate to SurgiBox. When I’m on clinical, I focus on my patients 110%, and I’m lucky to have a team that understands that aspect of my life. Some of my clinical colleagues are raising families or running marathons, and instead of doing those activities, I help with my company. It was a similar story in medical school with everyone doing a million cool things. For me, I treated SurgiBox logistically and mentally as my main research project, so I could look to my clinical mentors in both research and entrepreneurship to learn how to balance my time between SurgiBox and clinical responsibilities. It takes a lot more time than the average research project, but that’s okay.
Can you talk about how as a founder in medical school, you got the team around you? How did you go about finding a team that was so able and willing to accommodate your lifestyle and responsibilities? To answer your first question about how we found our team, I can’t exactly say that in a fair way. We kind of ended up finding each other. We’ve been pretty blessed and happy that a lot of folks who got excited about SurgiBox along the way were able to help out in a lot of different capacities. We got a chance to know numerous people and entities really well, and if it felt like they could contribute in a discrete fashion, they might join for some part of the project. However, if they felt like over the course of time they wanted to expand their roles, we were usually able to accommodate them as the project expanded as well. So it was very ad hoc with the goal of focusing on what SurgiBox needed.
Aa a medical student, what did it mean to recruit all these collaborators? As I started out, I felt that I was merely a medical student, so why would anyone want to talk to me? But I was pretty surprised. I think regionally (and really even beyond) it seems that folks are pretty used to the idea that people from Boston (or maybe it’s people crazy enough to want to go into medicine) have some fun ideas and that they’re really dedicated to pursuing. So I really didn’t see the level of barriers to respectability that I might have otherwise experienced. Having champions, mentors, and supporters provide introductions along the way really helped out.
What would you say you enjoy the most about your work? That’s really, really tough. I work day in and day out to provide outstanding clinical care at hospitals regionally that I know are absolutely state of the art. I get to know that when I’m not doing my clinical work, I’m working on something that can help raise the bar for places that don’t have all these benefits that we’ve historically been able to enjoy.
What would you say the biggest challenge has been in getting SurgiBox to where it is now? The discourse around SurgiBox really changed, so the biggest challenge was leveraging that well. In the first year or two, whenever I would bring up the idea of SurgiBox, listeners would often ask, “Why in the world does safe surgery even matter if people are still dying from all these other things?” Then data came out from WHO and the Lancet that global surgery is really needed to save a lot of lives, and it’s a very cost-effective way to do so. For example, if a patient has a broken bone that can be treated via safe surgery, they can return to their lives as a contributing member of society. As more data came out, the conversation really shifted away from why surgery even matters to how do we make surgery safe and scalable? Unsafe surgery incurs quite a bit of cost because if you’re doubling someone’s hospital stay after they get an infection, your surgical capacity is diminished since you have to take care of patients for longer periods of time. It’s also ethically wrong to subject patients to a lot of preventable complications. These realizations made the adoption of SurgiBox a lot more exciting. It also helped that members of our team and advisory board were early visionaries who emphasized from the beginning that if we’re going to make surgery more accessible, we need to make it state of the art. So we’ve been able to benefit from all these things.
Where are you in the process of bringing this product to market? We’re currently running human factors trials, which is one of the first big requirements for the FDA. We’re running simulations with the idea that we’re trying to confirm that SurgiBox is easy to make, easy to use, and can be used in a way that will fit into people’s surgical workflow. This process means testing it out with surgeons who may have never used or even seen SurgiBox before, so it’s giving us fantastic information.
The next steps after that would be manufacturing, FDA and other regulatory approvals, and getting it out to the field to make sure it works as well as we think it will. Overall, we’re focusing on ethical development.
Could you talk a little bit more about the whole entrepreneurial process, the role you played in that process, and what it took to get SurgiBox to where it is now? I’ve had the opportunity to talk with as well as work with a lot of stakeholders and build an understanding of how SurgiBox is useful to different organizations. For many of entities, their biggest attraction is that we make surgical fields more sterile. For many providers, especially those with experience fighting Ebola (one of the few rescue techniques was to stop internal bleeding surgically, which was very dangerous for surgeons), one of our big attractions has been that we make the providers much safer.
It’s exciting because we’re working with non and for-profit partners to explore strategic relationships. It's pretty exciting to get SurgiBox on a path to development. We’ve also been lucky along the way to get institutional funding and support from MIT, Harvard, and the Harvard President’s Challenge, so it's been a wild ride so far.
Where do you see the company going in the next five years? Five years is a long time! At that point we will have hit the market and will have had some clinical impact. We have a number of different markets, which you can find on our website, and I’m hoping that we hit each of them. We’re expecting that we get more traction in our higher value markets so that we will be able to develop economies of scale to reach places where there's less access to surgery as well.
I think the next five years will see us developing more of an impact. And I think the fun of it for us will be to partner with trainees like students and all the other folks we’ve worked with to ensure that safe surgery becomes an inextricable part of global surgery and really all surgery.
The founder of the Geneva Foundation of Medical Education and Research, with whom we are collaborating, has gotten me excited about several of her passions. One of them is ensuring that as they’re expanding access to safe surgery, there’s also a widespread respect for ensuring that everyone has access to high-quality, safe surgeries. I'm hoping that we’ll get to embed ourselves as a part of that dialogue and that people, patients, doctors, nurses, etc. are all safe.
Can you talk about your career path, background and how you got to where you are? SurgiBox is very interesting for me. I did some work in antimicrobial resistance and a few other things in the past, but nothing quite like SurgiBox. When I got involved in SurgiBox in the first place, I was getting an MD/MEng degree, which was a fairly novel thing at the time. So, I worked with a lot more biomedical engineering and medical devices, and I think that's a big part of what I want to keep doing. I’m currently doing a lot of SurgiBox related work and I'm hoping it'll stay a big part of my career going forward. I also want to stay clinical because I think that nothing is quite as inspiring for me as seeing and helping patients.
I’m also fortunate to be involved in leadership positions and with medical devices in both Boston and Rhode Island. Those opportunities are very exciting for me because I get to see the breadth of what is available out there. Many trainees in academic centers are exposed to so many brilliant opportunities. The smart ones will take ones to broaden both their skillsets and mindsets.
You’re doing all this work on improving surgery all over the world, so why did you decide to go into Internal Medicine? I love it! Along the way, I always knew I wanted to go into Internal Medicine. I thought about surgery, and I loved my surgery rotation. I even knew that when we got to clinical steps with SurgiBox, I would be doing a lot of surgical site analyses. The question ultimately became, does it make sense for me to keep going forward with this project (SurgiBox) that was at its beginning stages. Overall, I think that a life is a life, and if you can help your patients in any way, I don't think there’s a difference whether I’m saving a patient’s life as I prescribe medications, take care of them in the CCU, or help keep them from dying in a field hospital. All those things are very cool to me.
Additionally, I feel like when I was in medical school, there was a feeling that medical devices were something that companies did and individual doctors didn’t. I think that's terrible because we’re the ones taking care of patients by using and relying on devices which have limitations. We kind of treat these devices like black boxes, which I think is unfortunate. In my experience, many times, the devices are what keep patients alive. So, I love it when doctors or future doctors want to take increasing control of what we can offer patients through these devices.
What advice do you have for future medical professionals? You want to do something you find exciting. From a practical standpoint, particularly for me, I knew that SurgiBox was something I wanted to work on even after a 30-hour call. It was just so invigorating and worth it for me. Instead of just saying follow your dreams and passions, which is very hard, think of it practically. Do something that you’ll want to be doing even after you're absolutely exhausted from working towards your dream. Then, you’ll always find it worthwhile.
Do you find that you had to develop particular skills which helped you along the way of managing both the entrepreneurial and clinical aspects of your work? Constant skill development under pressure. One of my last clinical rotations before engineering school was on medical ICU, and I remember how absolutely terrified I was on the first day of MICU. We had incredibly sick patients on ventilators and on vasoactive drips through a million tubes, lines, and drains to try to keep them alive. I remember thinking “I have no idea how I can understand any of this!” However, as with every other rotation and like every other trainee, I began to understand how I could be a useful part of the team, and that the patients and families appreciated that I was there. So, if I could go from being absolutely terrified to being almost comfortable, I think everything else seems pretty doable by comparison. I think that's what we (physicians) bring to entrepreneurship: if we carry forward that “can-do” attitude that we’re compelled to have in medicine, we can really solve anything.