Graham, I elevated your question to the Manager's Choice for a bit. I'm interested to learn what members think!

And allow me to expand for our outside-the-US members: What countries are best?

Joerg Schulze-Clewing We just started one in Ohio this January, in Elyria which is near Cleveland. The state was quite accommodating and appears business-friendly. They have MEMS resources and Cleveland Clinic Foundation is there, depending on the nature of the business that is being planned that can be important.

The number of people with BS/MS degrees is less important in my opinion. In this day and age one can work from nearly everywhere. Our folks are quite scattered. For example, I am in Northern California.

When it comes to business-friendliness and political majorities I have my rather firm opinions on that but I bit my tongue before I get into rant :-)

Saeed Sokhanvar, PhD, PMP I am seeing lots of activities in MA specially Boston and Cambridge

Bruce Youngman The midwest "rust belt" seems to be doing a good job of re-inventing itself within the medical device market. Michigan, Minnesota, the Chicagoland area. Taking and using the technical expertise, manufacturing capabilities, and skills from suppliers originally tied heavily to automotive. Universities, technical schools and research institutions are there as well as the beginnings of venture capital support and other entrepreneurial support is taking root. Interesting to see the transformations occurring with much of it (in Michigan) being more "grass roots" than government led.

Cross California off your list. Cal has it's own FDA, so you double your inspection, registration and annual payment hassle. Plus the expensive housing market makes it very difficult to get people to move here.

Interesting perspective, John.

Coincidentally, and as of this writing, the top six geographies for Medical Devices Group members are San Francisco, LA/Orange County, Minneapolis, Chicago, New York, and Boston.

Joerg Schulze-Clewing Joe, where did that information come from? Like John said, I see med devices folks moving out of CA, for obvious reasons. One is my former employer that is packing up a large operations and moving it to Costa Rica.

Perhaps one best kept secret for start up medical devices and medical-related companies is Raleigh-Durham, NC area. The research triangle region and extending areas are ripe with resources, universities and entrepreneurship. I work with many dedicated and exceptional professionals with expertise in the field. Might be work considering, given the economics and great place to live. Business economics shifting to more friendly incentives.

John Notarianni Come to Indiana for all the right reasons. It fulfills the majority of the criteria you list. An established manufacturing infrastructure -- It already has a significant base of established device companies like Cook and Roche Diagnostics. State Tax Incentives, Research Universities like Purdue, IU, Notre Dame, Ball State and U of Evansville. It is also a Right to Work state.
Contact Chad Pittman, Exec VP Indiana Economic Development Commission for specific information and opportunity. The Town of Zionsville, Indiana, just north of Indianapolis is actively looking for a high tech company to locate in its new industrial development area and has incentives.
JN

In Southbridge MA, there are loads of old mills and such that could be converted into fabrication houses and hold just about any size of equipment. I am not sure of the infrastructures of some of them and it would be an investment.
The state does offers some very appealing tax breaks an incentives to people who hire it's citizens so my vote is Massachusetts.

Courtland Imel Wow, no one has mentioned Texas yet. I guess I need to mention that Texas is only slightly business savvy - leads the nation; only slightly inventive - leads the nation ten times over the rest combined; state dollars to start a business with special dollars for regulated business; a very understanding local district office as Mr. Rodriguez speaks across the country on medical devices and provides the national model of the FDA/industry coalition; select cities have set up special incubators to drive medical device development, including operation of development facilities to offset development costs and initial product costs; top medical schools in the country; well trained people; no taxes; no taxes; no taxes; no income tax; no business tax; and finally, we have a governor that leads the nation in finding groups to move to Texas. We love California and New York and Massachusetts. We just ask that you keep your liberal/progressive opinions there. We also expect you to attend church and attend Texas induction classes. Oh, we lead the nation in fighting this oppressive government and the nation in military inductees.

Sandra (Sandy) Hyndman As a federally incorporated Canadian Company, I have to agree with some of the post from Joe Hage as to San Francisco, LA/Orange County, including San Diego. As a previous Registered Nurse to an inventor of new medical devices and at early stage previously living in Vancouver B.C., I was fortunate to find my polymer engineer who walked the walk with me through this new industry. From polymers and the manufacturing stages to a finished business plan, FDA requirements and ongoing research with corporate electron beam accelerator industries such as A.E.C.L. Manitoba; E Beam Services New Jersey; Stanford, Berkley: IRT San Diego a wealth of research was learned. From this research I continued work as an electron beam, polymer and FDA consultant in Vancouver , B.C. with clients who wanted R & D sterilization of medical products with dosimetry validation results.
Adding, the visit to medical device trade shows in Anaheim and the large support I received from medical device suppliers at this show made my decision that California is and remains my preference for early stage and start up. Finally would mention a number of great universities that have offered assistance. To incorporate, I would do this in a tax free state that being Nevada. So California is the place I want to be. Thank you Graham for this post and to everyone responding.

Sandra (Sandy) Hyndman Did I say tax free in Nevada, my apologies to everyone as I got caught up with Courtland's previous post on medical device companies in Texas... and no taxes, no taxes ! ! Well all I can say is lesser taxes I understand to incorporate in Nevada if deciding business activities in S. California. Still residing in Ontario Canada and at the negotiations table I got carried away for a moment. Many thanks.

For European market, France can provide good level employees with high productivity and some taxe incentives (Crédit d'impôt recherche), but the lack of flexibility of employment, the high taxes (social, company and personal) level and the complexity of taxes (just look at a payroll and you'll understand) and laws and a suspicious administration makes France a country I would not recommend.

Jerry Robinson The "best state"....

Is one to realize your vision at something you can afford... somewhere that there are like minded people that are pursuing their visions at a reasonable cost..

General "business answers" - don't matter... Get your business up and running then figure out where you should be...

It's good to think about Austin, San Diego, Minneapolis, and other places of innovation....

**********
You might go to Kickstarter or IndieGoGo... look for projects similait to yours.. build a spreadsheet - and see where these places are at.. If a "certain location" has a large number of sane, funded startups.... then that is a good place to start comparing your home too...

Smart people who understand the business and process are ones to hang out with and talk about your "own" particular effort...

Where funding is at for YOUR effort - is a big consideration.. Funding (jobs...) to support your initial efforts - and perhaps the "smarts" to continue funding if it grows..

Tapan Mukerji St.Louis is growing at a fast pace.
Responding to Joe's question regarding which countries are best, I should say India could be considered for R&D and design, while for manufacturing China could be better. Of course nearshore locations like Uruguay is also being preferred by US companies.

FLORIDA, FLORIDA, SOUTH FLORIDA:
Jupiter has Scripps which is a huge research and testing resource and there are also many smaller independent testing and research labs of every type. There are 5 big medical and dental schools in the lower half of the state...U of M in MIami, USF in Tampa, FSU in Tallahassee, Nova Southeastern in Ft. Lauderdale and UF in Gainesville.
There are many med device companies already in the state and a business friendly atmosphere with plenty of available, affordable space to set up manufacturing facilities. Good, well educated and skilled people are easy to recruit since it is a desirable place to live with no state income tax and a great climate. Public schools are good with Science and Math Magnet programs. The culture is rich and diverse and Florida cities and towns are safe and beautiful places to live and raise families. With many new technologies targeted to address the needs of the aging boomers, Florida also has the target population at hand...it abounds with well-to do, well informed seniors and a very prominent medical and dental community to match those needs.
Florida does a great job of recruiting businesses to relocate to the state and the economic incentives to do so are worth investigating.
Fort Lauderdale - West Palm Beach and slightly north into Martin County on the East Coast and Tampa and surrounding up to Tallahassee on the West Coast are worth investigating.
Everyone comes to visit and ends up deciding it is a great place to live and work.

There is no one size fits all. Minnesota has a tradition of medical device start-ups and possibly has the headquarters of more device companies than anywhere in the world. But a poor infrastructure for biotechnology. As these two areas move closer together the choices of location become more complex. Early stage groups should probably locate close to home home and worry about location once established. My advice is to be as virtual as possible throughout the developmental cycle and think global from the day you open.

Courtland Imel Sandra,
Our Texas legislature removed business taxes from scientific start ups and small businesses. Yes NO TAXES!!
Good luck,
Courtland

Silicon Valley. Talent. Technology. Innovation.

Ori Epstein Broadly, the Southeast is becoming a great place for medical device companies to start up and/or relocate. Of course as a Georgia native and resident I am going to have to specifically say Georgia!

Resources:
Georgia is home to the Saint Joseph's Translational Research Institute (SJTRI), a world class medical device and therpeutics innovation center and one of a very few private institutions in the country.

Georgia Center for Medical Innovations (GCMI), a state-of-the-art product development center that increases the speed at which medical innovations get from concept to market.

World class institutions such as Georgia Health Sciences University, University of Georgia, and Georgia Tech.

The Southeastern Medical Device Association (SEMDA), a nonprofit association headquartered in Atlanta that supports and promotes medical device companies throughout the Southeast

Transportation:
Georgia is home to the busiest airport in the world, Hartsfield Jackson Airport. Because of this valuable hub, every city in the continental US is, at most, a five hour plane ride away.

The Port in Savannah, Georgia is poised to become one of the busiest ports in the country once the Panama Canal expansion is complete with transportation arteries connecting it to major cities around the Southeast.

Tax and Business Incentives
Medical device companies performing research and development work in Georgia may be eligible to receive the Research and Development (R&D) tax credit, a lucrative credit that can be monetized even if a company has no revenue and a tax loss. Companies that locate their business in certain areas can qualify for jobs credits that can also be monetized immediately.

Jonas Moses, PhD PA Re: Dr. Soby's comment about Raleigh/Durham NC...

Lynn...it's hardly a secret. During grad school, which for me ended in 2007, all of us students were talking about moving to the Research Triangle, for medical device work!

Respectfully, Dr. Jonas Moses

Paul M. Stein Kiplingers has had some discussions regarding the "Best States for…" very recently. Nevada and Texas were posted as very tax friendly. But, they are not now major medical device hubs, although the latter is moving fast (Austin, Houston). California, Massachusetts, and Minnesota were stated to be very tax unfriendly, but we all know how many medical device companies are there. Hence, right now, things are kind of upside-down financially, so none fits all of the original discussion criteria now. Because companies can move, it will be very interesting to see where the demographics may take us into the future. I do see Ohio (Cincinnati in particular), Indiana, and North Carolina (Research Triangle Park) poised for growth in the long-term. The last one probably fits the best balance of all of the criteria for the "Best State" for medical device companies, although few are there now.

Ram Ramalingam I think southern California(SC) may be one of the right places for medical device start-ups; with highest concentration of medical device companies in orange county and San Diego, SC could provide talent, regulatory resources and a pool of experienced part-time and full-time employees in several areas. Regardless of the misgivings in business climate, SC and Bay area together top venture capital investment in the entire country. At this point of time I think no where in the country "entrepreneurial mindset" is prevalent as in California despite you can find elements of it in bit and pieces in the res of the country

What a robust conversation. Every once in a while I'm compelled to just say "thank you" for making this group a joy to manage. I hope many of you pencil in May 13-14, 2014 in Minneapolis to meet in person at the second http://MedicalDeviceEvents.com.

Joerg, the readership (and other) statistics about the group are (typically) found at http://www.linkedin.com/groups?groupDashboard=&gid=78665. I say "typically" because LinkedIn redesigned Groups this week and that data is temporarily missing from my view.

I think it might help to be more specific, in knowing what kind of company one would be starting, not just the actual type of device (respiratory, ortho, etc.), but also is this to be inside or outside sales? Are you focused locally, regionally, or nationally? If inside sales, then consider local and state taxes, and any business-friendly incentives. TX and NV are the two best in that aspect. Outside sales would render demographic research, i.e. population of patients and/or hospitals/clinics.

New Jersey meets all the criteria except state tax rates. The current governor Christie is Republican, is business friendly and highly.likely to be reelected in Nov.

Noam Shamay US in general will be the target market for sale of new medical devices, yet to develop and test medical devices today it is the EU that can provide the market first centers to use the new device. In that regard the US - VC`s and angel syndicates needs to play with Universities to perform. Relocating a company in "start-up mode" to the US can be done only if financing is available and for a success story, strategic US partner is involved.

I think a good place might be Israel , with 50% of the cost for development and clinical evaluation, experienced teams that had years of good technology runs ...no wonder that some US corporates are doing development work here.

Reading the posts I will have to say that I like all of you, yet I will have to chose Miami , Good weather and sailing (:

Colorado, nicest place to live and work in the country.

Paul M. Stein Jonas, and any others wishing to know, the issue with public university systems automatically owning company technology if any work is done there is a nationwide legal issue. I tried to get a simple, inexpensive animal study done, and went from Texas to Minnesota to California, running into the technology transfer lawyers within the various "University of's" all basically saying the same thing. All were quite willing to do our study, but because they are all public institutions, they have a legal obligation (501(c)(3)) to force shared ownership. Anyone with half a brain would say forget that. So, we're ending up getting a whole lot less for a whole lot more at a contract research organization. NOTE: Private universities do not have this issue, but they can be fairly snooty about who they work with and why. It's a very tough system, but if successful, it can be worth it.

Ori Epstein Paul- to add to your comment this is why Saint Joseph's Translational Research Institute in Atlanta is so unique. One of a few such places in the country not owned by or part of a University.

Burrell (Bo) Clawson "If you are a medical device company looking to start up/relocate to anywhere in the USA, which state would you choose?"

Startup: Where you are for initial work is the most likely, unless you need a lot of special services from other states during the startup and you can afford to move and take the time out to do so.

Relocate: This is what you do after the startup, where you pick your location for how to best serve your customers from a shipping standpoint, your best cost environment if margins are tight, your need for labor supply/costs, access to critical sources including people.

There is another option which is NOT discussed in the press that I can remember. Look at the question at the top again.

Canada has programs to encourage US firms to locate medical development in Canada. I listened to David Fransen, Consul General in Los Angeles speak on this a few months back in Newport Beach. There are considerable tax incentives & a trained work force speaking English. see www.considercanada.com

Jonas Moses, PhD PA Noam, I agree with you that Israel is an excellent bet, at present. As regards your comment: "VC`s and angel syndicates needs to play with Universities to perform," you have a significant misunderstanding about the way things work. It is not the VCs and Angels who lack an interest in working with the academic institutions. This is a problem with US universities - they insist on owning all of the innovator's IP, and do not know how to commercialize from within the institution. I have been dealing with this, both as an academic research scientist and then Private Sector innovator, for many years. Even for those university systems that have created technology transfer activities/offices, the process is horribly dysfunctional.Here, in Texas, the UT System has completely disenfranchised Private Sector R

Paul R. Garrett, MD The value of having a Univ. nearby is accessibility to recent grads who are talented and want to work. I agree getting involved with the school's bureaucracy is not helpful.

Andrew Kyle While somewhat tainted by living here in Texas, I would recommend it for the following reasons:

The largest medical center in the world, the Texas Medical Center, is located in Houston. It size is hard to imagine as it, by itself, has more sq feet of space than all of downtown Dallas.

The state has discovered huge oil resources and those will fund education - the wealth of UT and other institutions is based on the oil extracted from dedicated state lands. This resource base will keep Texas taxes low and fund education and state infrastructure.

The attitude of Texas is business positive.

We like to say be as big as you can in Texas. Its up to each individual and organization... not the state or government.

Sandra (Sandy) Hyndman Robert Bard, I must say that your post here is rather lame and not consistent to the original post. First I might say that when you refer to other countries, meaning your words Canada and Poland, two you randomly chose by stating you believe are not part of Canada. I mean who posts likes this, Robert ? And to add this original post was expanded by Joe Hage, after Graham introduced the topic which states, "if you have the time to check.."for our outside the U.S. members."
You state you lived in Richmond B.C. Robert, and that Quebec is legally French when you refer to documentation. Once again poor wording for someone in the medical device industry. As a Canadian or anyone else, Robert you are not introducing us to a new fact about Canada.
Finally in addressing Courtland's post from Texas and stating if he was serious or not was out of place, as were your remarks on state religion, state politics and the governor of Texas. Your post seems rather obscure with points from Poland to Canada to Texas to Mexico. I suggest you answer the one question originally posted and try to stay focused. I found your post unfocused and rather confusing in answering the original question, which state is best to start up/relocate if one is in the medical devices industry.

I agree, Georgia Is a great place. One item you overlooked Ori is Georgia Tech.

My vote is for Atlanta, GA. Speaking from the trenches. i.e. a start up med device company, I must say that almost all of the ingredients are here as captured in Ori's post. Low operational costs, great incentives and access to world class talent and technology. The one ingredient relatively lacking was money but that too has now been improving....

Burrell (Bo) Clawson There are often two distinct phases in a new medical business.

It may well be that the "startup" may be in one location for convenience, where the key pieces in the long product development process are underway, which can often take 3-5 or more years with new products. Many of the aspects of the development and commercialization plans might be done in disparate locations, as is often the case, because of specialists located in various different states or even countries.

A later funding round from VCs, a corporation or private investors may influence the last phase of the startup.

When the product is finally FDA cleared and put into production, the economics & timing of production and shipping of products may make another location the preferred spot for the public headquarters and production operation.

I believe it comes down to your business intent. Do you wish to become a fully integrated medical device company or are you a startup looking to partner. If you want to become fully integrated find a incentive friendly state with low cost of living and high quality of life, if you build it the talent will come. If you have selected your potential target partners then be close to them, say Warsaw or Kalamazoo. I'd stick with the MidWest.

Paul R. Garrett, MD To add yet another state, I would mention the First State, Delaware. Famously business (read tax) friendly and good geography for major medical and engineering culture in Philly, Hopkins and Princeton-- even NYC is fairly close.
Watch out Courtland, they do have some progressives there, though.

Noam Shamay Paul, Jonas, are we talking development of products?
Paul did these universities asked you for ownership or part of your IP for doing work for you?
I Just completed an animal study for a new minimally invasive device in Tel Aviv university in a major animal lab here in Israel, it was fast and professional work. No one had anything to say on sharing anything but a modest fee for the lab and staff, a standard services agreement.

Stuart Taylor Definitely not California!!

I recommend Central Europe, I mean countries like Poland, Slovakia, Hungary or Czech Republic. Easy to find professional workers - high educated and laborers, much lower work costs than US, Japan or Western Europe, very good job culture, taxes maybe not most friendly in the world but not the worst as well, generally lower than Western Europe. This direction should be always consider

I have to agree with John Hoppe, about California. For your start-ups, California is not the place to be for sure. Joe points out that the highest percentage of the membership for the group is from California and the other largest states, however that is because their are large populations in those states to begin with and there are a large number of well established profitable medical device firms already located in California and the other big states. Yes, California has set up their own FDA and they do regulate medical device companies with an iron-hand. I have observed it first hand.

There are many other downsides to starting a small medical device company in California, such as high taxation, governmental red tape, few benefits are offered to small new companies, and the workforce labor rates are higher than most other states, not to mention high rates of employee disability claims, and generally high rates of tardiness from work.

Nevada has no state tax so this might appeal to some companies. Don't forget the southeast states like the Carolina's and other states where there are prominent medical schools and universities, and low labor rates and hard working workforce.

Texas. It's often overlooked, but I'm seeing lots of star up activity here. Lots of tech companies have large operations here. Centrally located, with easy access to major airports. Also economically feasible-and I moved here from CA.

Charles D Robbins III-MBA,CMfgEng It is simple, Washington has the highest educated work force with the lowest relative pay scale in the US. Plus, Washington has the research Universities to support this type of business development.

Robert J Bard, JD, CQE, RAC Sorry Courtland, I could not tell if you were being serious or not but a lot of the thing he said are the reasons I don't suggest Texas to my clients. Not all company really want a State Religion or want to be part of State Politics and yes, we have seen the Governor of Texas on TV.

I worked for more than twenty years in California and the negatives are somewhat overcome by the rich talent pool and access to support infrastructure. Florida and NC are also great for cost control as is Nevada. Western Michigan is also looking like a good place to set up shop as is the area around Ann Arbor (vacated by pfizer).

The northeast has a lot of medical device companies but it is crazy expensive. I highly suggest that anyone looking to setup or relocate in the US to check the resources that are available (buildings, infrastructure, personnel, test facilities, molders) without these, it really does not matter what the tax structure is. Big Country with a lot of opportunities.

PS. As the question was posed, I don't think Poland or Canada are officially part of the US. I have worked in Canada (Richmond, BC) and it can be more expensive and taxes can be a problem (and depending where you setup don't forget about about having to have translation of documents into French (Quebec is legally French). Also, Canada is a foreign country with a lot of different law and regulations. Having personnel have to cross into Canada daily or weekly or month can be a real pain (the Canadian Border guy are not the friendliest). This is true of Mexico with slow border crossings. Sorry Arkadiusz, I found Poland regulators to be almost impossible to work with...never made decision.

Courtland Imel Robert,
I am a strong conservative. Grew up in the Panhandle of Texas. I am a devout Christian, Texas Baptist. I am a member of Convene, which I suggest to all. Yes, come here, we do seek Sunday morning fellowship. Our churches are large, many with 5000 members. My forefathers on the Mayflower would be pleased. But we are not here to discuss religion or politics.

However, we each have passions and desires to see people receive help for their ailments. We each have passion for our states and areas. We each have a passion to see others succeed.

I did try to add humorous statements of truth. I know that Rick is targeting Missouri this month. When he targeted California, we had many businesses move here and more to come. If you would like your state added to Rick's campaign, let me know and I will pass it along to the Governor's office.

The third coast is alive and well.

Paul M. Stein Noam, I'm sorry to get back to you so far down the stream, but this discussion is so popular. Public universities in the U.S. are looking for either shared ownership of the IP or in the form of an upfront contract for a percentage of future royalties on the product. It's all based on U.S. law regarding 501(c)(3) institutions (University of …, State University of…), and every potential contract gets immediately shuttled to the lawyers in the tecchnology transfer offices. So, unless one has some personal altruism towards particular institutions, these are to be totally avoided.

Paul M. Stein Ori, agreed.

Jim Gustafson MN, no question: already, per Newsweek 2010, 22% of employees in the greater Twin Cities are employed in the medical technology sector. That's a larger % than computer workers in the Bay Area (21%). Taxes are too high, but the work force is cheaper than TX or FL, and many local suppliers know now to provide for medical device companies. Also the MN congressional delegation, both D and R, are solidly supportive of the industry, and the local FDA office knows its stuff, and is reasonable.

John Notarianni I agree w Courtland Imel, not Robert Bard.
If I were starting a company or wanting to relocate a company I would certainly consider Texas. The states on the bottom of the list would be California and Minnesota --- regardless of how high-techy they may be.
Courtland, save a few acres of Texas land for my wife and I -- Texas is looking better and better as a place to live these days -- and values and politics and ARE legitimate reasons to influence where one lives.

Dr Srinivas RAO
CEO, SITALOGICS (www.sitalogicsglobal.com)
Tapan: Absolutely right.India can be the R& D hub.
BMDK ,Kansas can help in translating the research and commercialisation of technologies coming from such R&D hubs

Alan Barta I'd put it where other medical device companies are. CT, MA or RI are good. Overseas, Geneva, Switzerland; not so much pacific rim in Asia, but you might consider San Jose or Seattle. You'd get tax breaks in RI. FL has all those huirricanes to deal with. Climate, colleges, and workforce are top considerations if starting from scratch. Disagree with starting just anywhere, then uprooting workers to suit whims.

Now occupying companies might have a say in local governments. Once competitors, Ford blocked Lincoln from opening an assembly plant right next to theirs in fear Lincoln would steal best workers with better pay. So lay of the land and scale of industry are real considerations.

Quality of life, skilled workforce, captive audience (HQ locations for health related companies), tax incentives and healthcare mindset...I'm biased but I'll put my vote in for TN after checking the box on all of the above.

No interest in NY? Can't understand that. Ha Ha.

Charles D Robbins III-MBA,CMfgEng Traditionally the device and Pharma startup have been in New Jersey. Recently, Mass. and Calif. are the states that have started most of these companies. Washington has the highest umber of college graduates. Frankly, I would pick the state with the lowest taxes for start-ups and the least amount of burocracy. That eliminates east and west coasts.

Burrell (Bo) Clawson Charles, I would agree, except that in the beginning and for many years, startups usually don't have significant, if any, income taxes to pay. Other taxes yes.

I don't have an exact answer, other than to think that the principals need to make the best choice for their situation.

Joseph Mandell I should clarify Courtland Imel's tongue-in-cheek comments about having to convert to a Christian Conservative in order to live in Texas. Please understand that the mayor's of Dallas, Houston, Austin and San Antonio, which are the primary drivers of the Texas economy, are all Democrats. I am not trying to get into a political fight or advocate one political party over another, but Texas is not as Red and as conservative as some may believe. Our governor supports stem-cell research and has even undergone stem-cell treatments for his back. In 2007 the state established the $3 billion Cancer Prevention and Research Institute of Texas (CPRIT) which provides grants for cancer research and prevention programs.

Rather than pointing to politics, I would like to point out that Texas has diverse and skilled workforce with some of the most prominent hospitals and universities in the country. The tax advantages that our state and local governments offer is very appealing too. The military research that is taking place at Fort Sam Houston, in San Antonio has made major advancements in the development of remote surgical procedures, biorobotics and trauma care.

When you all think about Texas, I hope you think about the potential and not just the politics.

Jean Bigoney, RAC, CQE I'll put in a good word for New Hampshire.

Along with quality of life for the outdoors minded (enjoy hiking, fishing, hunting, skiiing, boating?) and a business friendly state government, the small state of NH boasts a own world class medical center (Dartmouth-Hitchcock) on the west side, and proximity to Boston (without the taxes and the traffic) in the southeast.

The NH High Tech Council features a Biomedical forum for member companies involved with pharmaceuticals and devices.

Ali Hamadeh I would add Salt Lake City in Utah.
The environment is business friendly, low taxes, low energy cost and the
area is beautiful (mountains) and the real estate is reasonable.
Good colleges (UoU, BYU) provides good talents in engineering and technology.

Indiana is home to several medical device companies and has lots to offer new ones.
Jack E. Parr

Tom Mariner I love the fact that enough people feel strongly about their geographical area that they will flog them here! From an economic development point of view, the medical device industry is tough to beat -- high tech, medium margin (2.3% off the top is a disincentive to innovation) but still attractive to the economic development crowd.

I, of course, have my own area to tout -- Long Island and the rest of New York State! We are a 45 minute train ride to the fastest growing high tech area in the country, Manhattan, and home to amazing research, development, and economic development organizations. But you'll have to put up with reasonable home prices and did I mention beaches and The Hamptons?

But open to all areas plea's for innovative firms who serve our patients. No Really!

Bo has a number of very good points. The stage of the developing company is relevant and location choice will likely change as the company meets its milestones.

I think Micheal Porter identified significant attributes that empower an industrial cluster;
1) Factor conditions (e.g. labor, infrastructure, finance)
2) Firm conditions (competition, management, morale, interactions)
3) Demand conditions (relevant customers that request "state-of-the-art" solutions)
4) Related suppliers (competent vendors that understand requirements)

For early stage (discovery) medical device companies the key is the Demand conditions. Are there medical visionaries (doctors) that are looking for solutions. MN used to have this leadership with U of MN and Mayo (especially in cardiac and surgical areas) but as the research cultures slowed the vibrant medical discoveries shifted to other areas. MA still has favorable demand conditions in biological/pharmaceutical/medical areas. North-CA also has favorable demand conditions. But I am impressed with the Cleveland Clinics' approaches. But many of the novel Demand conditions are coming from outside the USA (including 3rd world needs). The alignment of a Medical Champion with a novel solution is a lost art in the current University IP control environment and the "not made here" cultures of large corporations.

Many communities have adequate employee bases and infrastructure; and it is hard to pick a favorite here. What sets communities apart is their flow of "high-risk capital". All over the USA risk capital has slowed significantly, especially for those development projects that face significant regulatory pathways. I would suggest that the northeast and northern CA still have the most fluid risk-capital pools; and they like to invest locally.

Access to related industries/suppliers depends on the technology (implantable devices - MN, polymers - OH, biologics/pharma - CA or MA, software/hardware - many locations). However, even if your company does not reside in areas with quality suppliers I would suggest that you pull them into your projects; experience counts.

After considering these aspects I think that the best would be to find a committed Medical Doctor-Partner in a region with good risk capital flows and locate there; then contract with suppliers from regions that have the greatest experience. Facilities, taxes, transportation and quality of life issues can all be considered at the next stages of growth.

Sandra (Sandy) Hyndman This post is to Stan as you have just mentioned a committed Medical Doctor-Partner. I feel qualified in addressing as a committed Medical R.N.-Partner. You mention medical visionaries (once again addressing doctors). It is the nurses who utilize the medical devices and here at Toronto Hospital a human factors group along with the University of Toronto have been using nurses behind a glass portal to demonstrate the effectiveness of new prototypes.
Doctors are not really involved with product assurance of medical devices nor the regulations governing such which is essential in order to pass the FDA regulatory committee in Maryland. I know as most Doctors are too busy with their own practise to get involved. The nurses are really the ones that are invaluable in providing ideas and novel ideas towards the manufacture of new medical products.
If your refer to my earlier post top of this page, I have spent a number of years thoroughly entrenched into the medical device industry. I myself am the visionary, as I have begun Can/U.S. patent filing on a mobile compact sterilizer, a disposable airway with a better bite block and the redesigning of 5 plastic disposable treatment trays for easier access by health care professionals. Since much of the health care market has moved into the communities, many treatments have to be done at home and many times by a family member. To add I am interested in the biomedical waste accrued after disposal of contaminated plastic trays.
Many thanks for allowing me to extend upon my previous post. I thank Graham for submitting the original post as I have enjoyed and have learned so much from each one who has posted. I am enjoying the opportunity of marketing myself and my innovations as really from early stage this is what I believe much of business is all about, that being marketing.
Once again Stan thank you for opening the door for my comment. I know the medical device industry thoroughly and I and you have found a committed Medical R.N.-Partner who wants to help with solutions. I am a medical visionary who wants to make a difference.

We are seeing a large growth of Medical Devices in Oakland County Michigan. Check out Medical Main Street http://www.medicalmainstreet.org

Why Michigan:

* Our Governor has improved the tax structure here in our state. C-corps pay 6% flat income tax and LLC and S-Corp pay NO business tax anymore. He has also slashed like 50% of the regulations that prohibited businesses from growing.

* Engineering Powerhouse-- Michigan graduates more engineers per capita than any other state in the USA. Here in Oakland County, 46% of our residents have at least a bachelor's degree compared to the US average of 29%.

* More US patents per capita awarded in Michigan than anywhere else in the Nation. That's why the only other office of the US Patent Office outside of D.C is in Southeast Michigan.

* Close network with suppliers-- check out our " Michigan Medical Device Manufacturers Directory" on the Medical Main Street Website... From engineering, to prototyping, to precision machining--- you can find all here in southeast Michigan.

* Your customers are here-- all within an hour's drive of each other you can connect to the largest concentration of purchasers of Medical Devices

* Henry Ford Hospital
*William Beaumont Hospital
* Detroit Medical Center
* McLaren Health
* Karmanos Cancer Center
*St. Joseph Mercy Hospital
* Trinity Health
* University of Michigan Health Systems

* and several other more

* Again with an hour's drive of each other you have access to close to 40 medical research centers focused on medical devices (from materials, to electronics, to IT, to mhealth) you can collaborate at some of the top researching minds at Oakland University, Wayne State University, Michigan State University and University of Michigan.

Basically a one-stop-shop! Plus Michigan has some great incentives for companies locating in our state. Very competitive.

Did you know that Oakland County Michigan (Home of Medical Main Street) has more device companies than Minnesota and North Carolina?

Did you know more clinical trials are done here in Southeast Michigan than anywhere else in the nation?

We are not just automotive! What's cool is to see the devices that are being developed in our region and seeing traces of automotive technology in them..

See why over close to 100 medical device companies have invested over $850 Million in Oakland County's Medical Main Street in the last 4 years.. There's a lot going on !!

Burrell (Bo) Clawson Sandra Hyndman brings up a really key point which is often overlooked in new product development, which I have experience with in my own products. The vast majority of my respiratory disposables products have been used by nurses and RTs, not normally doctors.

My current diagnostic kit is used almost exclusively by nurses and PAs.

Doctors simply do not have time to do everything and keep up with everything.

For start-ups...go where the money is. Many correctly pointed out that start-ups & tax liabilities are an oxymoron as start-ups have no money. It's targeting the investors who have the money & the states (or countries) willing to provide tax incentives to those high-net-worth investors willing to risk capital in order to stimulate early-stage funding...if you're very lucky...deck is stacked for only certain models, I believe.

Good engineers & design shops with proper tools & design / development / prototyping equipment are also important, but those are seemingly in abundance and conducting business remotely for these services on contract is relatively easy & simple.

Good labs / universities are obviously critical to start-ups as well from a research perspective, especially for med device...and the IP issue is a real problem with them as has been stated. This issue is challenging the universities as much as it is challenging the private sector/start-up enterprises as the universities are well aware of their inability to commercialize or see the commercial value in much of their in-house (faculty/student) derived IP (their track records are generally poor and we see ROI rankings within the Big 10 conference of schools for example here in Indiana) and are trying to figure out how to partner with the private sector who might have solid commercializable IP without requiring all, or a majority, of the IP in order to engage simply because having a part in something that succeeds is better than a massive IP portfolio where nothing brings value.

One of the underlying issues tied to this original question & the role of the state & the academic community is that the seemingly "excellent state & public/private infrastructure to support medical device start-ups" can actually be a deterent for a start-up. In my experience, the political elements, in their usual good intentions, are always looking to stimulate economic activity in an effort to create (or save) jobs. They love the ability to make "public / private collaboration" statements in the media, & feel like they can outsource much of the heavy lifting to the well-infrastructured univertities for the science & IP, with the commercialization efforts being funded by a large company from the private sector (much later in the funding / development stage & once that IP is ready to go to market) & thus tie all of the state's tax income for economic development initiatives & stimulation into categories which don't always make sense for the start-ups...

Ultimately, they are forcing new med device IP & innovation into the universities & squeezing it out of the private sector (garage inventors / physician inventors / entrepreneurs / & very small start-ups lose). Then, their model encourages large public or private corporations to license the IP from the university to commercialize it & then pay royalties......so, all those (big) players are happy.

Not all business models and start-ups are structured in this way, however. When the small company/entrepreneur/ physician in the private sector comes up with the medical device innovation / IP & then attempts to raise funding very early in the process, it is near-impossible to find private angel or early-stage or even federal grant funding because no one wants to risk capital that early (regardless of investment tax credits & other stimulative measures by the state) & wait that long for any returns. Universities also then crowd out the federal grant dollars because they have the PIs, lab infrastructure and the academic backing, and maybe even the downstream licensing / commercial partner in tow already.

I am not sure if the "what state or country" is relevant for the start-up/entrepreneur with a medical device innovation in the current business environment. Certainly relevant for the established business or later stage company going into commercialization & marcom phase...and in those cases, I would suggest the Hoosier state!

Don Kloos Forbes Magazine ranks the states in order of 'business friendly' as do many others. I suggest a quick Google search. See: http://www.forbes.com/sites/mikepatton/2013/03/31/the-most-and-least-business-friendly-states/.

Top Ten (Most Business Friendly): WY, SD, NV, AK, FL, WA, NH, MT, TX, UT

I'm in CA, which is ranked 48th out of 50 on this list. (I don't need this list to tell me that!). Though OC is considered the 'med device capital' (300+ companies), CA is in decline. We were once one of the top 10 economies of the WORLD. Our current political climate has buried us.

This is not 'med-device friendly', per se, but there's enough overlap, I think.

Jerry Robinson Lots of great comments...

I think the current mHealth landscape is one of "confused seas"... there are a lot of choices, approaches, and ideas...

In the "microcomputer world" of days gone by, many companies located - in many places, all over the US.. lots of approaches worked for a while.. As time went on, the "choice places to be" narrowed down to a few general areas.. I think the same things will play out.. but not in the same fashion... this time, mHealth is VASTLY bigger - and has VASTLY more entrenched traditional med types than ever existed for microcomputers.....

That said..

start with Cost and work your way up... A room in your house, a web site, accounting software (basic), and Incorporation... Kind of least cost startup at perhaps as low as... $400 - 500??? sound about right???

An office at an incubator... $50 a month plus $350-400 liability insurance...... Say $950 for a first year.....

***********

So where would investors or grants come from to start up and get going?

Don points out the BEST place now to be... and I think San Diego and the OC may be among the best now... but in the long run, it will be different.. so you PLAN to change - based on how your venture shapes up...

*******************

Business friendly TOTALLY depends on scale... and creativeness.. (EG... San Diego is expensive.. so BUY an old boat - that you can live aboard - and try that... Creativeness early on sets a long term tone...

--jerry

Theresa Hoegstrom I'm in FL (#5 out of Forbes Top 10 list). There are many reasons to hold your place of business in this state:

Not only do we have Mickey Mouse and his friends along with lots of sunshine... but we also always have tourist dollars coming in (not to mention those tourists may sometimes need healthcare while they are here), a huge elderly population that sucks in the medical/health supplies, great hospitals pumping out the volume, and there are many medical device companies that have found homes in this great state, and that number continues to grow.

Beyond the opportunity in your backyard, there are great high-ranking universities located in FL, some of which have very high scores for the caliber of engineers they produce. Intelligent people waiting to be staffed...

FL is a top exporter of goods as well. Great location!!!

Ori Epstein Aaron - to your point:

"For start-ups...go where the money is. Many correctly pointed out that start-ups & tax liabilities are an oxymoron as start-ups have no money."

Georgia has a program that allows companies to immediately convert to cash "Research and Development" and "Jobs Creation" tax credits, even though they have no tax liability.

It's a very unqiue program that can help stimulate growth at the company level.

Jerry Robinson There are many levels of startup - so many answers would work... The problem is that you have to look at the long term for any type of "effective valuation".. but you have to plan and pay for the short term....

It's not just money - its the "type of money"... Just remember that there are too many scammers, quick buck artists, parasites, and "pillagers" out there... This has to affect your startup location as well.. EG: in the OC or San Diego, there are LOTs of ways to get scammed, parasite'd to death, or "costed and fee'd" to nonexistance.. It's part of the landscape.. Still, it's a very, very good place to site startups in certain ranges...

--jr

Joel Blatt It seems like the best place is where you feel most comfortable exercising your entrepreneurial spirit - a combination of social, cultural, financial and political factors. Having started up a company in Silicon Valley, I naturally feel most comfortable in that rich environment. The confluence of electronic and medical expertise is unsurpassed. But your individual needs may be best met in another environment. "There's no place like home".......

Burrell (Bo) Clawson Jerry Robinson noted "t's not just money - its the "type of money"... Just remember that there are too many scammers, quick buck artists, parasites, and "pillagers" out there..."

Unfortunately, I've seen way too many of these types. In the beginning they are all for the startup. Then on the last day the meeting/call turns aggressive as they want to change the terms of the deal suddenly.

It is difficult to detail how to avoid this, other than to put it in writing A-Z what you are willing to do for $X & how, so it is in black and white on day one after your attorney works it over with you.

Successful start ups need technology and the right people. After that some money is helpful. However without the people the technology is going nowhere so successful start ups end up having to go to where those people live and that is not necessarily a business friendly environment. MA and CA are great areas to find the right people but they are also very costly areas in which to start a new venture. The business plan must weigh the two factors.

Buffalo, NY has a burgeoning medical device sector, with stalwarts like Greatbatch Medical and Baxter (former SIGMA Intl. - smart infusion pumps) and new spin outs emerging from the University at Buffalo and other research institutions. In addition to great R&D and innovation, the region boasts a highly productive workforce with a manufacturing heritage.

New York’s Governor Cuomo has recently announced major initiatives to attract startups, including:
START-UP NY tax-free program, where startups and existing companies that work with a university can operate completely free of all state taxes for 10 years, INCLUDING personal income taxes.
Buffalo Billion Business Plan Competition – part of the Governor’s unprecedented Billion-dollar pledge to economic development in Buffalo, this competition will award a total of $5 million in prizes, with the top prize earning $1 million!

In addition, Buffalo has a growing venture and angel capital community, with the annual Bright Venture Forum coming up at the end of September.
LAUNCH NY is a nonprofit modeled off the successful JumpStart Cleveland to identify, support and invest in high-growth, high-impact companies and catalyze the entrepreneurial culture of Upstate New York through regional collaboration with ecosystem partners.

Have you been to Buffalo in a while (or ever)? A visit will certainly surprise you!

Joerg Schulze-Clewing Tim, nowadays many companies can run via cyberspace. Location matters less then, so you can pick one with a favorable business climate which does not have to be in your own state. That is what we are doing with our start-up. There's a lot of hardware involved and the occasional trip is needed. That's what the airlines are for. But other than that it's all about web conferencing, desktop sharing, 3D CAD files, mulling over ideas just as if you were in the same room. Works very well. The only (minor) gripe I have is that web conference services mostly do not have a decent enough whiteboard tool where everyone can sketch at the same time, without having to turn over sharing privileges. Also, one should not skimp, in my experience the cheap or "free" services do not work well. But for around $50/mo one can subscribe to a nice and robust web conferencing service.

Did you know that Greatbatch (a leader in medical device manufacturing) moved its headquarters from New York to Texas; Frisco, Texas to be exact. The reason? Well isn’t it obvious? Because Texas is awesome – but also because Texas has a growing medical devices industry and Greatbatch wanted to get in on the action. Dallas has a reputable medical device sector; Greatbatch relocating it’s headquarters not only confirms this, but shows Texas is well on its way to becoming a niche in the medical device market.

Read our blog article for more information: http://www.fideliscompanies.com/2013/05/16/texas-a-state-of-biopharma-growth/

Alan Barta Find Joerg's comment to be unsettling. As a prerequisite, medical devices must be manufactured sterile and nonconforming quarantined in highly specific ways. So location does matter a lot. Preponderance of evidence shows that you just can't produce anywhere. Web conferencing has its place under umbrella of travel expense reduction in a decentralized, large corporation, not a small startup, or only among office workers, not assemblers and producers. No doubt, huge corporations do have continually audited suppliers, but that is more safely and typically done by travelling. Countries like Iceland are good target for startups, where the way is paved by governments and labor eager to please and support. But manufacturing is rebounding in USA after decades of unsuccesful attempts to reestablish plants elsewhere to exploit cheap labor. You get what you pay for.

In my experience, a very under-appreciated factor for setting the location of ‘start-ups’ is the source of funding.
If a start up firm is lucky enough to obtain professional VC money, then one condition may be to locate (or move) the company to the funding source’s backyard.
• Easier and more frequent monitoring of company activities.
• Easier for the VCs to integrate their existing network of experts and consultants into the start-up’s processes.
• VCs’ comfort-factor with the availability of quality candidates to fill positions in the start-up as growth allows and requires.

Alan Brewer

Texas is the best state for business period. There is no state tax. Land is available for minimal investment. The infrastructure is in place to compliment start ups &/or on going concerns etc.

Definitely Colorado. We have a highly educated workforce, new University Medical Center, tax structure that is not onerous, Colorado Bioscience Association which does an amazing job of helping our Med Device companies on both the state and federal levels PLUS the healthiest folks in the country. We are already #6 in the nation for number of Med Device firms.

Andrew Kyle I think Frank summed it up well. Texas does not place barriers in front of your ideas nor motivations. What do you want to spend your time doing - (1) meeting state regulations, taxes and overcoming union barriers while starting up your business or (2) your business? Second only to California in population and with Dallas and Houston together having 41 of the Fortune 500 companies (trailing only NYC at 43), the population of 20+ million in the DFW-Houston-San Antonio/Austin triangle, and shale oil discoveries that may hold the second largest oil field in the world, the opportunities are here... Not too much snow either.

Alan Barta Texas! You might as well say Europe! It's huge, has all sorts of places that are completely different, and seems to have a slew of prisoners including more on death row than anywhere in nation. Yet most of it is empty desert or tornado alley. On the other hand, none of that is far removed from issues across most of USA. Might beat Buffalo or Detroit. Easy to speculate from a safe armchair in a cubicle. Tough to be an entrepreneur taking chances and trying to minimize risk, believe me.

Joseph Mandell Rhode Island!

We have golf courses in Texas that are bigger than Rhode Island.

The population of just our professional athletes here in Texas is larger than the entire population of Rhode Island (By-the-way: 5 Superbowl wins, 7 NBA Championship wins, and 1 Stanley Cup... we are still working on that World Series win).

The only thing higher than our percentage of uninsured drivers here is Texas is Rhode Island's unemployment rate..(sorry that was kind of low).

Graham Billey This is turning out to be a very lengthy discussion, I am impressed! I want to thank everyone for sharing their opinions, and especially Joe Hage for promoting this topic on the Medical Devices Group's main page.

Keep the responses coming!

Graham

Alan Barta Joe: I grant you that! Rhody workers make a short commute to MA, which has the least unemployment in nation, ~5.5%, and most medical device headquarters/manufacturers including biggest brands. Texas is only surrounds things not near each other, so ought to give plenty of incentives.

My bet would be one of two locations, One would be Salt Lake City Utah and the other would be the New England area particularly the Boston Area

Joseph Mandell The commute from Providence to Boston in traffic is probably the same as the commute from Austin to San Antonio or even Dallas. Besides, you don't have to land in another state just to get to our major cities you have to do for Rhode Island ;-).

Alan Barta It's an hour from Boston to Providence, but twice that in worst traffic, but you don't necessarily have to enter Boston, since most medical device makers are situated outside. RI does have a major jet terminal (PVD) within 10 miles of Providence, though it doesn't accept heavy metal 747s like Logan. Along its longest axis, it only takes an hour to pass through country's smallest state, which is about all you can stand of it. Confusion persists despite so little to know.

Jerry Robinson Almost everyone has approached this from the "High End Down"..

How about starting from the LOW END up... Where are you now.. how do you get your first set of offices and how much does it cost.. what manufacturing (PCB, Plastics, ETC... resources are local)? this area has kind of been a "no show" area for companies in IN - OH - MI - IL for a while.. amazing resources for manufacturing and design - but not plugged into the leading edge of Med Tech...

**********

Got to think in different channels, too..

WHERE is the best place to float a Kickstarter or IndieGoGo project? where are the motivated creative designers needed?

Too much stuff here about "business climate" - but not related to getting a "inadequately funded" startup off the ground... Commuting, Natural Gas, Football, and Tax are not front end issues.. local permits, fees, insurance... those are business killers...

Washington State has both a very strong Life Science community with WBBA and variety of angel investment forums that support Life Sciences deal flow as well. I also agree that Utah has been very active in supporting Life Sciences.

Most likely It would be close to top research doctors and hospitals. These will most likely be your first customers and close collaborators. Here in Minnesota, there are a number of doctors who are involved or have started companies. There are also two metro areas, one is Rochester where the Mayo is, and the Twin Cities where the The U of M is. There is also United Health on the Healthcare side. It also helps that Digi-key is in Minnesota, too -Cheap overnight parts.

Sandra (Sandy) Hyndman Roger Williams, we have already introduced previous topics that research nurses who are involved or have started companies are the visionaries for novel medical products. As a Canadian R.N. with my California R.N. License, there are a large number of nurses who own their own business. Do not fall under the assumption that because one is a Doctor, that this qualifies them for having knowledge in the medical device industry and that they have knowledge about medical devices and the medical device industry.
As mentioned in my previous post, most Doctors are too busy with their own practise to be involved in research and medical device accreditation. The majority of physicians, if not more, depend on the nurses who use the medical devices to educate them about novel ideas and the business of such.
Adding, many Doctors are not aware of the enormous numbers of grants as well as scientific research and experimental tax incentives that are provided by governments to assist with Innovations and technology, Life sciences and Cleantech.
I am familiar with these grants both Canadian and U.S.and some in Europe as I have always had a passion for the criteria to be eligible for grants. I have been fortunate to have received two with a present one pending in Toronto.
The marketing of novel medical devices branded " designed by a Registered Nurse", would be the turnkey to selling medical device products, particularly to Doctors clinics, retail, wholesale, the home heath care market, laboratories, and to large Corporations such as J & J, Baxter.
Many thanks for this post Roger.

Nick Yang Dear Graham: I am very happy to hear, you choose US for your start up medical device company. I only can tell you, you choose the right place because in the USA all your thinking or consideration factors will not the problem at all. I aslo would like you to think about the transportation. What kind of medical device you would like to manufacture and what kind of transoprtion you will go to need it.

Michael Kremliovsky Let's just be straight: a startup company opens where the founders want to live. In very rare cases, there are state incentives (like Singapore's fund) that make people move. Apart from financial incentive (which tells you where you need to relocate), to balance your work and life you need to enjoy the place. The taste is different, so there can be some variations. Legal issues and labor laws are relatively unimportant for a startup. Access to people is important, but this aligns well with where the founders want to live. After all, they also need buddies.

When you are searching for relocation, then the question to answer is why? What makes it wrong to stay where you are? How are you going to move your people? When it comes to R&D (which medical device is heavily about), you should think about people. Thinking "cheap" is the way of the past: the problem with short term saving is the long term stagnation. I saw medical device companies moving around, but they rarely close their facilities. Instead, they open new ones. Owners may complain of bureaucracy, but this is because nothing is perfect and bureaucrats also want to live close to a beach...

Jerry Robinson Absolutely right, Michael!

It's also not just "one thread" that you have to think about....

If you looked at available cash - either yours, as a small local group, or something larger - what kind of cash resources will be available? This starts to narrow your options....

Here in Dallas, there are several startup incubators.. That doesn't mean that they help everyone... or even close.. There are just too "MANY" Flavor of the Month Startup support sources.. and that may or may not help you...

A low end plan says that you might fund $50 for an office (with "free internet/power/kitchen access" and some basic liability insurance (may be $350-550). This is if you have to pay for yourself... There are always places that will charge more - and ALL OF THEM will tell you what a good deal you are getting.. which sometimes your are...

There's a lot more that one can talk about - like mentor support, low end startup business advice.. and COUNSEL so you don't give away the farm!!!

My point is... You start with "if it's done in my living room"... as a base.. then the next comparison is "if done in low cost incubator/subsidized/borrowed space...".. and then start adding comparisons from there.. leaving the living room adds more cost - but it can also gain benefits.. each type of approach / solution starts increasing cost - and adds another set of benefits/cost to the comparison....

By the time you get to "what state am I in"... that's pretty far down the road...

Most times - you need some basic "professional" face to what you do... If nothing more than to encourage you to get out of bed at 6AM and start HACKING... ie... the low cost incubator/borrowed space path...

Michael is right about the beach (and you DO know!!!)... but that means a lot of the basics on cost and finance are addressed...

It's like a gaming simulation - in many ways...

Courtland Imel Jerry,
I agree that Dallas, Houston, San Antonio, Arlington, Frisco, San Angelo, Lubbock, El Paso, Temple, Athens, etc., etc., etc., each have biomedical incubators. Each one has relationships with the Angel Investors network, state funding, mentors, and space for rent. Due to the huge variability of devices, Texas provides sufficient space, freedom, knowledge, expertise, etc. Investment in Texas is just as diverse. Each group across the state gives start ups multiple opportunities to do an elevator speech before numbers of VCs. I also agree that starting a business in the living room is best to conserve cash. We work with a large number of start ups that are ready to move from. The concept stage to the actual product stage. The most fun that I have is connecting two or more groups together that really need each other. One problem we have is the lack of coordination. We must all continue to fight for coordination. It's only 3 hours from Dallas to Houston or Austin. We need to participate in more regional meetings.

For the rest, our regional groups cover an area equal to about 15 states.

Alan,
You are right. Texas is a small state. We drive 60 miles or about a 15 to 20 minute drive for lunch in the Panhandle. You are right, the lone tree planted there in 1889 died in 1985 from the heat and lack of water. We like it when the wind slows down to about 45 mph so we can travel to the grocery store. It sure beats Chicago for cold in the winter. I just never understood why Ford and Chevy paint their vehicles, when sand blasting is so cheap and free. In winter, Wind chills are about -30 to -45 degrees. Like you, I love twisters, which is what we have. I hate tornadoes. Most tornadoes are only about 2 to 3 miles wide and rarely move south of the Red River. Them tornadoes are good for cleansing the landscape and getting rid of Yankees. Interestingly, we also have hurricanes that brings tons of rain in the fall for spring flowers. The rain changes our brown landscape to blue. We call em blue bonnets. They grow all over our desert landscape in about 4/5ths of the state. We grow cotton, wheat, cattle, wind turbines, and oil on the rest. Only in Texas do you receive monthly payments from the local oil companies for pulling black goo from your ground, just for putting up a house wherever you like. One thing I also don't like are the Comanche and Apache raids. We have Rangers, but they only play baseball these days. We all carry guns on the hip, ride horses, rope cattle, and wrestle bulls. We learn to shoot people that don't talk like us at an early age. As far as inmates and death row, we gotta do something with all these Yankees. If we can't convert them, we gotta get rid of em. No, we all think alike pretty much. We teach kids to think this way starting in kindergarten. We call it Texas appreciation and Texas history classes. That way, we minimize diversity and maintain our religious beliefs and conservative voting block.

I do need to correct that it does take about 18 to 20 hours to cross the state at our posted speed limit of 95 mph. If you drive under 100 mph, get out of my way. Running horses are hard to stop.

Further, thank each of you so much for your comments from my previous posts, therefore, bribes, kick backs, entitlements, and other financial donations can be made directly as a b to b transaction. I would be willing to run for governor or president. President does sound better. The Republic does need to return. I would also expect the return of Louisiana, Arkansas, Oklahoma, New Mexico, Colorado, Utah, and Wyoming upon secession and return to the Republic. We will call it the "New Earth", Heaven on earth. Texas. No place better ever. For those that disagree, remember we can split into 5 states minimum, or 75 states if we use average area per state. I guess a voting block of 150 senators might change the view, huh?

Robert Feldtman For any of you guys worried about a "State Religion" in Texas.... we'd rather not have you here anyway. What a stupid comment...cheez.
Texas has it's own power grid, infrastructure. Nobody has talked about business continuation in case of disaster. Don't like tornadoes, pick Houston, Don't like hurricanes, pick Dallas, or best of all San Antonio. Good travel hubs (DFW, IAH). Business taxes advantages already addressed. Where are the major internet hubs? I think Texas is one. Biggest medical center in the world - Texas Medical Center in Houston.... second biggest is one third that size. But it sort of depends here the money is (venture capitalists) and Texas is replete with money due to it's healthy business climate.

Jerry Robinson Courtland...

It's Taco Tuesday in SoCal - in lots of places today....

I have not found the level on funding commitment in Texas that I saw in SoCal or NorCal. That was in the early days of microcomputers, though... In general, if I have a novel idea or approach... in my areas... I get a much better "hearing" in California than Texas... and I live here.. and am FOCUSED on a tech area... So... promoting the state can be fun, but pretty unrelated to the immediate necessity of creative people hoping to move up from Ramen Noodles, unemployment, and keeping the power on... Its an adventure, not that I don't enjoy it...

Michael Kremliovsky I think UK is a terrific place to start a medical device company. It is a pretty vibrant place for medical device startups which is closely followed by Switzerland (go, figure!). Single payer makes it attractive too as long as the single payer is on your side. Good access to talent. I always regret that I don't have an EU passport, so I can exercise that freedom... Israel is another place where, I believe, we observe the highest density of medical device startups in the world. By absolute amount of startups this is the ranking: USA, Israel, UK, Switzerland... USA is by far ahead of the group (>10x of Israel, but is also infinitely larger).

Tennessee, of course!
And I know everyone's looking at me kind of funny, but humor me. When you're in a startup, it's all about ecosystem. Who's there to help you? What programs exist? Do you have access to key opinion leaders? How hard is it to find customers to validate your concept? Where do you find manufacturing? What hospitals/clinics will be a beta customer you? What's the availability of funding? Do you have access to device companies that could end up being an acquirer?

Admittedly we're in an virtual age and that makes you have a shot at success from just about anywhere, but even though that might (eventually) be the case, there's no doubt that starting up in the right ecosystem has a *huge* effect on your chances for success. A great place to start up includes entrepreneurship programming, subject matter experts/opinion leaders, industry players, mentors, and of course, availability of capital. Tennessee, and Memphis in particular, is home to the headquarters of Wright Medical as well as divisions of Smith and Nephew and Medtronic, so clearly there is a nice core of industry players, and professionals who know the industry well. In addition there are academic and research institutions like the St Jude Children's Research Hospital and the University of Tennessee Health Sciences Center. There's even a brand new GLP research lab equipped to take care of a range of pre clinical work. Memphis is also home to the Campbell Clinic, who wrote the textbook on orthopedics. What this means is that there's a wealth of expertise in medical device research and manufacturing. Besides St. Jude, the Medical Center is home to several hospitals including Methodist, Baptist, Le Bonheur Children's Hospital, the VA and the MED (Regional Medical Center at Memphis). About 40,000 people work in the Medical Center area, allowing excellent access to medical professionals for all stages of device development.

Memphis is also home to several contract manufacturers, including ones having ISO13485. Granted, manufacturing can be done just about anywhere, and some of the best manufacturers are elsewhere, but it's good to know that you can have local manufacturing if you choose to.

And what about that hard-to-get startup funding? This is a problem everywhere, but over the last few years, Memphis has created two seed/early stage funds that focus on medical device investments and bridge the gap to the larger Series A rounds. Another thing is that the state has taken a very active role in spurring on the development of entrepreneurship in general across TN. They've put their money where their mouth is and launched a fund to match investments so that if a Tennessee investor invests in a local company, there is a matching percentage that can be applied from the state fund, essentially adding up to 50% (depending on the amount of investment) to the value of the initial investment.

And then there's the other stuff that makes a difference. The organization I work for is focused on bioscience entrepreneurship. I actually run an entrepreneurship accelerator program (called ZeroTo510) that's focused exclusively on medical devices. It's a bootcamp style program that helps entrepreneurs get their device startups off the ground. We tap into the local expertise and put together a curriculum that takes them through entrepreneurship basics as well as the more device specific startup issues. We pair them with expert mentors, and we give them an initial equity investment thanks to a couple local venture capitalists. At the end of the program they get to pitch to the VC's again for follow on funding. For the entrepreneur who hasn't done this a few times before, this type of assistance can be the difference between success and failure.

While no place has absolutely everything, I hope you'll agree that TN, and Memphis in particular is definitely worth a look!

If you are launching a new product seems you would want to do that in Europe and avoid the FDA in the beginning . Manufacturing of your product could be anywhere and by anyone (qualified outsourcing partners). Goverment incentives, Tax, and time to market would be priorities for headquarters. Human capability can be anywhere but there is an advantage in new product development in having pools of people as opposed to a completely decentralized launch team. What your device is and the market it serves may be part of the equation but in reality that is not any different than any other market. Look at the largest device companies in the world....they havre a headquarters and then a ton of businesses they bought in all parts of the world and in all states. The advantage of being in a Healthcare heavy state like minnesota may also be the downfall. People leave companies and with them go many of the ideas . So more important than where is what....
What does your device do that makes it win.

I actually cant think of any company that started with where should I be and then said now that I am here I will make "this". Once you have a company you may move . Getting to funding might take a plane ride but money is not locked into a geography.

Michael Kremliovsky Joe, just a clarification: dealing with FDA has to do with where you sell, not where you develop. Also, EU is catching up very quickly and in a few areas they are already ahead of FDA in over-regulating.

Tom Mariner Joe, on the FDA vs. Europe. The regs are fairly close with the exception that third edition is required for all MDD submissions now, while the FDA / US allows grandfathering. And, of course, the US is a big market for useful medical devices (at least it was.)

I noticed that no one mentioned Wisconsin, yet. I have never lived in Wisconsin, but I consulted with several start-up medical device companies: the IL companies have to do everything on their own, until they gain a foothold. Whereas the WI companies get loads of help from the Wisconsin Technology Council and the Wisconsin Innovation Network.

Both trade groups assist with finding Angel funding; trade shows to get your idea seen; industry mentors to assist if you get stuck at a point in development; a rich pool of design and development firms to work with; and a strong government partnership to help "the little guy."

I actually had a discussion with an IL inventor about moving to WI to take advantage of the programs. The inventor chose not to move, and is not developing, but a WI company I consulted with made a great deal of progress because of the industry trade groups mentioned.

I know that Minnesota competes very hard against WI, especially since a great deal of established medical companies work in MN, but remember the question was about start-ups not the Greatbatch's of the world. (Full disclosure, I sold products with Greatbatch batteries and I own Greatbatch stock. I have no problem with Greatbatch, but let's not confuse it with a start-up)

Allan, I'm really glad you made such an informed pitch for Memphis. As an employee of one of the large companies you mentioned I wanted to jump in on this conversation, but it's a good thing you beat me to it since you said a lot more than I could have. The only thing I'll add is that the cost of living in Memphis is much lower than many other areas that have been mentioned, and the quality of life here is very good.

Burrell (Bo) Clawson Andrew has it right; right on as a matter of fact.

As we get ready to start, the first consultant on our list before anyone else is the FDA regulatory affairs consultant. He will help us design our company's system for 100% FDA GMP & CE Mark compliance from day one so we don't waste time later trying to undo or redo procedures which are not right for our product and processes. We will also decide then upon what is needed for added compliance with ISO standards we might want to meet.

You do NOT want to set up tests, procedures, trials and such without proper procedures & documentation.

Startup companies can't afford to put their head in the sand and "pretend" they are doing everything correctly. They need to know from highly competent in-house or contract compliance experts in the arena the company is working in.

Delaware!

I live in Maryland but I have been very impressed by the Delaware supports technology driven companies looking to start or build a business.

The workforce is great . UofD is on amazing rise in quality, quantity and application driven programs

The local biotech community is incredibly supportive and helpful

Local government is supportive, approachable and extremely willing to help. In addition they are much more available and understanding (unusually high level of tech savvy politicians)

Local Healthcare systems, such as Christiania, Nemours etc. have been attracting the best scientists and clinicians and are now blossoming into a great research engine.

It is also ideal for its location mid way between Philly and Baltimore, New York and DC

All of this is in addition to a legal and tax system that has long made it the best place to incorporate a new business

At Cresa Minneapolis, it's our business to help companies think through the multiple issues involved and get the right answer to this question for each specific company's situation. We work globally for big players like Medtronic and Patterson Companies, as well as small and midmarket businesses like Possis Medical, SurModics, SterilMed and Key Surgical, to name a few. No one answer is right for everyone, but if this issue is on the horizon for you, just let me know.

Jerry Robinson I think the Med Devices and mHealth devices are in a Confused Sea State right now... doing some now is the most important thing - first...

But I do think that - and this is really important - that if you are focused on traditional payment and funding mechanisms, then you are going to "miss it".. getting paid is ALWAYS good... but development with that as a primary criteria... risks missing the boat...

For us in this market, Smart Phones are the VECTOR to getting your mHealth device used.. Funding Mechanisms for smart phones - do not look like those for traditional med devices.. so LOOK AT WHERE SMART PHONES ARE BEING USED AND EXPANDING to define a marketplace and target customer groups... This thought process can profoundly affect the funding effort required for a startup..

A good product that works - can be developed and used in a small way - on the fly - outside the US. Experience can feedback into continuous development... Think of the "one step at a time" approach instead of the 'big, huge effort" approach..

Look what is going on in Smart Phone mHealth in Africa!! there are amazing things... and the NEED for Doctor/Nurse Force Multipliers is vast..

Start-ups can embedd this philosophy in their startup culture.. A very good thing...

Andrew Kyle I am a bit amused about the comment about avoiding the FDA in the beginning. To ignore the FDA from the start is a poor decision. The EU writes more regulations than anyone but the real boss if you want to sell into the largest medical market (and most profitable since the EU is socialized) you cannot ignore the FDA. In general, the ACT is huge and there are no "right ways" to document your requirements, planning, verification and validation activities unless you begin with those in mind. Even in the EU, FDA carries great weight - our rule of thumb is if we were on the OR table, would we want the physician to use devices that were designed to avoid the FDA oversight. The FDA resources are quite smart and have dedication to protecting the public from poorly designed devices. Read the MAUDE reports sometime on the FDA.gov site and you will see how many devices fail just because the designers wanted to "avoid" the FDA.

That being said, everyone in the USA has to respect the FDA. The states have additional regulatory and other burdens added on top of those already daunting needs. So I still say, the State of Texas limits those burdens a lot and does not have its hand in your pocket taking away money for the resources you need to build your business.

Andrew

Andrew Kyle Dr Keen,

Medicine is a world business. The regulatory requirements are intertwined. FDA will require IEC60601-1 third edition for new Class II 510(k) submissions after December for instance. To get IEC certification usually requires ISO certification to (13485?) and period visits by ISO auditors. These are usually announced and scheduled. The FDA, provided you maintain good practices and have a good track record, will usually provide notice a few days before they come on site. The FDA has full authority over export of medical devices, so to export to the EU from the USA, you have to ensure you are in FDA and GMP compliance. There are many companies who do not register with the FDA and who sell into medical markets without approval... undoubtly these are adultrated devices. Whether there are further instances of scafflaw like charging the 2.3% excise tax and then not sending it to the IRS... would be somewhat difficult to explain why a non-FDA registered company would be paying the excise tax and vice-versa. We as ethical medical device companies need to help the FDA shine a light on these entities who sell into our market but don't pay and play by the rules.

Noam Shamay Jerry thank you for these inspiring words and vision.
I think we hear the global waves clashing..
The way we heal people today can change at a pace our smartphones dose, These Ideas that helps the management of resources directed at lowering the cost and to tone up the effectiveness of our health systems will definitely have a better chance getting financed at today`s economic environment. US is a branding giant yet the US is not leaning on a stable growth economy these days. The regulatory burden , long development cycles, low reimbursement , and higher tax can make it hard to find cash for the "old fashion medical device start-up" (not health IT space) like start-ups developing devices to heal people not the health system illness.

I know I am generalizing yet, looking at getting a project financed i ask myself-

Is it more probable to finance my medical device technology start-up in the east or west today?

China and the east are investing huge money in new technology and they got it...

Being in Israel in the middle, I just hope we can keep on innovating here in the coming weeks ....

Andrew Kyle One last set of statements
I have a perspective of 40 years in the medical device industry
My first four years after graduate school was as a member of a DeBakey team working on the first computer based EKG monitoring system under NIH grant in 1969. Working with patients, in ORs and in the ICUs was a great learning experience to bring to the commercial side of our industry.

I joined a very small startup company in Houston called LT Instruments. It made ENG recorders and had just begun selling the first urodynamic devices in commercial distribution. In those days, the velocity from idea, thru development and to the marketplace was just that... go as fast as possible and get your idea to market. We had a lot of ideas and grew this tiny company into a $14M company over a decade developing many medical devices and sterile consumables.

About 1976, the ACT was passed and the FDA assumed regulatory oversight over medical devices. In those days, a 510(k) was a letter sent to the FDA stating you intended to sell the device and that was about it.

Over the years, the regulatory burden has grown to what it is today. FDA, EU, China, etc all have their hands in our business regulation. Quite frankly, the effort to start a medical device company today is quite a formidable set of barriers.

My recommendation is that the best State is your "state of mind". You must start with regulatory planning. Development and regulatory activities are co-dependent and must be in harmony to get your device to the marketplace. Venture capital has to be devoted to regulatory support as well as development.

For new ventures, get a trained project management professional (PMP) who understand how "projects" are organized and executed in effective manners with multiple parallel paths that have to have a critical time path to hit marketing launch dates and commitments.

Also, marketing has to be realistic! Just because Apple can make an iPhone 6mm thick does not mean that a new start up can do the same. Having worked in hand held device development, it takes thousands of work hours and many resources to create these technological wonders. You will be unlikely to have those until your success is achieved.

So - the old statement - P^6 applies... prior planning prevents piss poor performance!

Good luck,
Andrew

Jerry Robinson Comments are of very high quality and based on DECADES of experience here....

IT would make a VERY GOOD eBook to take substantive comments - expand a bit on them - incorporate some FDA stuff... and PUBLISH it.. "How to do it" and "Here is some food for thought" type books...

An editor could pick and compile a book - and publish it.. like more references to look at... Compile some of our experiences.... before you know it, there is a 100 page book - that can be REVISIONED yearly...

Such a book is needed - and would work well.. Perhaps not a LOT of sales, but there is some benefit in doing this...

Make sense? ...

Just an idea...

TOO OFTEN - in such groups there is TRUE WISDOM in commentary and like the waves on the beach, a passage of time buries the "gold".... it's good to publish.... and a little enough piece of people's time to do it....

Comments??

Burrell (Bo) Clawson Jerry, a quick pdf on a couple highly commented article subjects would be a good way to promote the Medical Devices Group here on Linkedin.

Joe Hage may want to put it together, or find someone with free time to do it.

Thanks for the suggestion, gentlemen.

Jerry Robinson Some of the commentary could be expanded - at direction from the editor... and that could make a really good, timely ebook... Sell on Amazon.. (hint, Joe.. :>)

Jerry Robinson I have found that a lot of people - (no surprise here, Bo...) don't have a handle of the physicality of taking thier "very good" idea" and instantiating it enough to get a product built and demo'd.. A good multi source reference guide - with Case Studies - is exactly the kind of thing that would help a LOT of people.. and get a lot of devices built and out there...

This is what Joe has pushing at, after all - in this whole linked in thing...

A lot of us "old codgers' have stories to relate... and it doesn't do us any good to "hang on to them" until it is too late, either... While we individually may not have time or inclination to do a "chapter" or a "story".. together there is a lot to say... and there are MANY levels in doing this type of effort....

--jerry

John Minarovich As I read though some of the comments I see that most are pitching their own location as the best state to start a company. I would just ask myself "where do I want to live?". I grew up in Texas, have lived in many places in the country from Hawaii to New York, and carried a bag for many years traveling coast to coast in the US and Canada. 25 years ago, I asked myself that simple question and chose San Diego and have no regrets.

If you are a smart, savvy businessperson you can succeed anywhere. So what do you like? The mountains of Colorado, the beaches of California or Florida, the lush forests of the Northwest or Mid-Atlantic, or the wide open spaces in Texas or the midwest? In my opinion, the best state to run a business is a state of happiness.

John E. Hamm I must agree with Michelle Duval and Theresa Hoegstrom regarding Florida. Many years ago Governor Jeb Bush started a Florida program designed to encourage medical / biotech companies to locate in Florida. Not only do we meet the criteria in Joe's original post, we have a very friendly business climate, state programs promoting educational opportunities oriented towards our industry, a great place to live with weather,recreation, and entertainment that draws employees and visitors here. Travel and surface transportation is another advantage that the entertainment industry has helped develop. Many of us also appreciate the lack of income tax here in Florida. Locate you business well, and enjoy the side benefits of beaches and year-round sun.

Jerry Robinson There is a real tendency to start with high level endorsements of an area... but that often has NOTHING to do with getting a startup going... John Minarovich has it pegged well...

Think of today's startup as a "step by step" process - not some big conglomerate... there is a place for the conglomerate discussion.. but not as a startup...

So... John... If you had $50 - where specifically would you locate and startup? How about if you had $500? $5K?... $50K, etc.... at these points, there must be answers in the process... What cities - locations - programs.... or not programs do you do?

A "journey of a 1000 miles begins with a single step" is a good philosophy to follow....

--jr

So many posts about the regulatory and tax climate in these various regions.

Interestingly enough, the most successful companies of all kinds are not different because of their operating locations, but different in that they have a clear purpose, vision, and core values that inspire others with similar ideas to join.

"People don't buy what you do, they buy why you do it" - Simon Sinek

Our big brains (cerebral cortex) is incapable of making a decision, yet it is where we analyze endlessly back and forth the advantages and disadvantages of being located here or there. In fact, the limbic brain is responsible for decision making, motivation, and inspiration, and it has no capacity for language.

Medical Device companies are founded by people with a PURPOSE. What makes them successful is how effective the leader(s) are in attracting people that believe as they do. It has almost nothing to do with location - we're all connected on the internet anyway.

My 2 cents anyway.

Michael Kremliovsky Bravo, Greg. Well said.

Sandra (Sandy) Hyndman Agree with posts from Andrew Kyle and Bo Clawson. I know that as a federally incorporated Canadian Company and an R.N. I respected the necessary criteria for new ideas for medical devices. The first thing I did was to register my Company with the Department of Health and Human Services (FDA). After this I began to complete the forms necessary for new products. I performed the appropriate research and discovered that the members of the FDA committee were physicians and others related in areas such as cardiovascular, respiratory, renal to name just a few. When you file for a new product this same FDA committee in Baltimore, Maryland must investigate your new product to agree that it does meet the safety and improved product criteria before you are allowed to go ahead. There is no going around this approval, and who would want to.In Canada our Health Protection Branch is not as strict as the U.S. FDA approval. I spoke with some American scientists about this and we agreed that Canada is not as regimented for approval of medical devices. To add what does not meet the criteria in the U.S. usually ends passing into our Canadian health care market. That is how it has been for some time.That being said I would much prefer going through the regulatory system (FDA) in the U.S. so any new product idea even patented, is thoroughly assessed and investigated. I would not want any product introduced into the health care market that would be a case for medical liability and primarily I would not want any product introduced into the market that would endanger the life of a patient.Many thanks again.

Ram Ramalingam At the end of the day location is up to founders and then later dictated by VCs (if you happen to fall in that trap). Israel and US are my top choices (especially in Israel with high density of medical device companies) to start medical device companies. Many in this discussion talks about talent is available in every US state, Europe Asia and beyond. Answer really depends on what you propose to do. Question need to be framed on what kind of talent that you need to make a breakthrough product from your technology? It is a myth that every university will provide the right talent. University labs provide raw talent for "a" technology; but to turn that technology into a product you need product development experts who can translate a technology into a commercially and clinically viable product. That is why I think California(US) and Israel are my top choices. I agree elements of California can be seen in Minnesota in medical devices( also Boston). Also, I agree California business climate is not ideal as Texas( from government support perspective!!!). Despite these misgivings, as an entrepreneur, I do not see big advantages in moving my company out of California.

John Minarovich Jerry, I grew up not far from you in Richardson, Texas, in the shadow of Texas Instruments and have seen the amazing growth of the area's tech sector. However, I would stay in Southern California, but look at Carlsbad or Vista. Although the biggest detriment to entrepreneurship in San Diego is stepping down as mayor today at 5 pm, the city's political landscape is still in disarray. Starting a small business gives you greater flexibility to locate where you want. As you grow, you can make decisions that benefit your company based on other factors such as manufacturing, supply chain, finances and human resources. But we also have evolved to a global environment that enables virtual management. I'd love to go into more detail, but I need to head to the beach....

Sandra (Sandy) Hyndman Thank you John ..agree the best state to run a business is the state of happiness... enjoy your time at the beach, as I will this long weekend in Toronto Canada.

For start-ups, you need like-minded people, talents, funding and the start-up atmosphere. Silicon Valley is still a good choice.

I agree with John Notarianni about Indiana but he left out a few key companies that are located in Indianapolis or nearby that make it a very strong in the medical device industry. A few of these are: Beckman Coulter, Zimmer, Biomet, DePuy Orthopaedics, and Covance. Indiana is making a very dedicated effort to build the life sciences portion of its economy. Another draw for Indiana is the cost of living is low and the commute times are generally more manageable than just about every other state I've seen mentioned above.

New Jersey - Pharm Country!

Theresa Hoegstrom As life would have it... here is a quick Infographic article about the Top 10 States for MedTech with some real stats: http://www.qmed.com/mpmn/medtechpulse/top-10-states-medtech-infographic?cid=nl.mpmn01

Jerry Robinson A GREAT Infographic!... Minnesota looks to be the most med tech centric & perhaps the place where innovation can grow the most...

Jerry Robinson John....

I worked at TI - off and on for quite a while... I enjoyed it, but innovative, product oriented solutions were never in the cards.. Frustrates me, as a design engineer....

The local Telecom scene collapsed was replaced by network companies... different mindset.. lately, it has seen explosive growth in insurance processing and services. It's a different mindset..

So there is potential.. but it is UPSTREAM SLOGGING compared to San Diego or Minneapolis..

I liked SD and the OC a lot, too....

Andrew Kyle I think the objective data shows that there are four major medical device centers. Except for California however, the weather would make me, were I locating a company, reluctant to use MA, MN, or Indiana. Really. The winter weather is not very friendly. You don't see retirees with options moving to these states for their ambiance.

Don't get me wrong, I have had great experiences in all those states... better in the warmer months... but not places I travel to in the winter if possible. I have to go to RSNA in Chicago in late November and just an happy if there is no snow.

So look to the future. Which of the ten top states have the brightest futures. California... wonderful state where I love to visit. Nice and temperate climate. However, broke and needs to raise money. The cost of a 1000 sq ft home cost more than my 5000 sq ft home in Dallas. I wouldn't consider the others for the same reason. Too little material return for your salary... the state gets it wherever possible.

In Texas, we don't have state debt.. Our oil resource base is growing so fast that the state and its main colleges which are financed by oil lands deeded to them by the State that our financial tax burden, already low, will stay there. Where is the growth in the USA... Boston, Indiana, Chicago, Minneapolis-St Paul? ... no Houston, Dallas Ft Worth, Austin San Antonio. Even Midland, now the second fastest growing city in the USA is going to build a 50 story building in the middle of the west Texas desert.

A 1.5 trillion $ Gulf of Mexico oil discovery announced in recent days will flow oil to the 25% of USA refineries and chemical plants. We have the Cline Shale play with 30 billion barrels of shale oil, the Wolfcamp shale with potentially 50 billion barrels, and Eagle Ford driving Texas oil production to levels it had in the 1980's.

So if you don't want your company taxed to its death, start it in Texas. More 500 Fortune companies believe in Texas than any other state. The migration is toward Texas. We now have 26 million citizens and are second only to CA. The Medical Center in Houston is the largest (3x larger than the next largest) in the world. Google it. Larger than all of downtown Dallas. I worked for Dr. DeBakey there and know its medical excellence.

Burrell (Bo) Clawson My Vote is: Start where YOUR best opportunity exists. All else is just noise.

Jerry Robinson Like Bo says....

the "Journey of a thousand miles begins with a single step".. is more than just a great saying.. True for business and every other organizational foundation, too...

Courtland Imel Jerry,
We need to get you on my calendar. I need to introduce you to the area. I suggest meeting with Doug Razor, since you're former TI. NTEC is having their upcoming party. Also join the FDA Med Device Alliance and attend one of the trainings/meetings. Texas has one of the most diverse and robust med device areas in the country. You have close to 375 device companies in the DFW area. I am well aware of the local TI issues as we approached TI with several projects. My clients are now running with those companies. You have another 100 in Houston, 100 in San Antonio, and another 150 in Austin, depending on whether you declare a company with income or start up. If you add start up, the
numbers increase.

Thanks,
Courtland

Sandra (Sandy) Hyndman Very pleased that this forum is still ongoing. A previous R.N. with many years research in the medical device industry, that is to say a medical device consultant with a health care background and a visionary for improved medical device products. I would be interesting in the last question that Graham introduced to this topic "Do any states actively campaign for medical device companies to relocate/start up there by targeting entrepreneurs and providing the resources necessary for the medical device industry to grow ?" I wish to add would the state also campaign for medical device companies and entrepreneurs who live outside the U.S.? Speaking here from Toronto, Canada I have mentioned in previous posts that I have followed the U.S. regulatory affairs approval system for years while conducting scientific research on new procedure trays and medical devices and the sterilization sources.

Lindsey D. Alexander http://medcitynews.com/2013/09/10-top-medtech-states-california-massachusetts-minnesota-wait-indiana-cracks-top-four-ranking/

Indiana is now the No. 4 state for medtech, according to QMed.

Michael Kremliovsky Interesting challenge for the thread: why, in spite of all said, California is #1 then? there must be something that we totally miss. Is it just weather? Really?

Burrell (Bo) Clawson Michael, I think it is critical mass in SD, the OC & SF/SV.

Over a decade ago, the OC Register had an article that said there were about 3500 registered medical device manufacturers/suppliers in the OC.

Michael Kremliovsky I want to dig a little deeper, so why so many people want to live and work in California? This is in spite of the very high cost of living, high taxation, "anti-business" climate, and so forth...

Jerry Robinson For a new startup, or an innovative one.. Bo is dead accurate right. New ways of funding - financing - and fundraising are here and will grow. That makes a big difference.. and the OC-SD corridor is a a fertile place to do new things.. You DO HAVE TO WATCH out for SCAMMERS though... as in all such new things, there are people and companies who prey on good ideas and new companies.

Michael.. you are cetainly more qualified than most to comment.. I think it has something to do with the willingness of the SC Business climate to consider new ventures - and it is much more developed than other places... The Porn business rose to great heights in SC... and it would not do so in such a distributed fashion anywhere else in the US. For a business climate, that shows something... Ditto with Entertainment and small venture startup support.

Just my opinion, here....

Sandra (Sandy) Hyndman Agree here with Bo Clawson. I have always understood that OC and surrounding areas have the greatest density for medical device industry operations. This being said, would the state of California which is already entrenched with medical device industries, campaign for medical device companies to relocate/start up there by targeting entrepreneurs and providing the resources for the medical device industry to grow. If so, would the state of California look to companies/entrepreneurs say in Canada. I know of one such Company in the Silicon Valley formerly owned by an employee of Baxter who hired nurses to design new trays. I was the one to approach this Company after I saw them advertise in Medical Device and Diagnostic Industry. They were interested in having me on the team, unfortunately timing was not to my advantage. My question then is, in already entrenched medical device communities such as SD, the OC and SF/SV , is there still a need for sourcing out, if the applicant and their medical device company has benefits to offer medical device industry growth in the U.S.?

Sandra (Sandy) Hyndman Certainly taking into consideration what Jerry has just stated. Just wondering if there is still a need for sourcing talents in the medical device industry outside the U.S.?

Jerry Robinson Outside the US... I don't know.. but I think that the best place to do something outside the US... is IN THE US in selected locations... the OC, SD, SV/SF.. Used to be Chicago.. Brooklyn.... certainly Minneapolis... there are large international, skilled communities there..

Make sense?

Theresa Hoegstrom In response to Jerry... I would recommend FL for a place to do business OUS (outside US). FL is a huge hub for exports given our proximity to ports. Miami has a huge following of local and international companies that use this to their advantage to move product overseas.

I consider that it depends on the company stage, and also speciality. If you are in a startup stage (0-6/8 years), developing your product(s), depending of investments, clinical and academic partnership and few, but specialized HR, it's essential to start near by this high tech regions (like CA). But, when you move to size up and productions phases, I agree that you should look for cheaper places with taxes incentives, including other countries. On the other hand, in a start up stage, as you depend on your main clinical and academics partners, you should consider the best place for your specialty field.

Make sense?

Katherine Kirsch I just began working with a start-up medical device company and we recently located to Grand Rapids, MI. Lots of hospital lab space and a welcoming environment (the have a great economic development non-profit called the Right Place that opens a lot of doors). Our company also has a non-profit flair to it and probably why we chose GR over other techy places in Michigan- grass-roots giving to development and education is prevalent here.

Good luck!

I think about it.
My answer is opportunities to join state-wide medical device organisations.

Corey Dowdle Growing up in Minnesota, and with a mother working for a Venture Capital firm which invests in Medical Start ups - I have a pretty good understanding of how good this state can be. For a start up looking to have its device bought or sponsored by a larger company, Boston, Medtronic and St. Jude are all right here in your back yard. There are also plenty of other mid-sized companies such as Covidien, Lake Region, Etc.. Also, if you are a start up with an idea, but not the resources to build your own product, there are companies such as MedVenture Technologies, Fast Forward Medical(recently acquired by Vention Medical) and Normedix, LLC(G Medix) whom you can contract to build or extrude your device. With that being said, I recently took a trip to Indiana and was impressed with the life sciences and medical device industry that I witnessed first hand - a state that seems to be on the rise.

hi Graham, for the detailed geographical analysis of numerous Medical Devices plz visit http://www.meticulousresearch.com/research-reports/