Surgical precision

The ultimate physician nightmare confronted Montreal cardiologist Dr. Robert Amyot one day in 2006 when he operated on a patient with a small tear in her heart.

Amyot performed a transthoracic echocardiography — a surgery he had done thousands of times. Yet the patient, a young woman, nearly died from the tear, an aortic dissection. The procedure, a team effort with a group of young doctors-in-training, Amyot says, was negatively impacted by “see one, do one, teach one.” That's a medical training practice where novice physicians work on live patients for educational purposes.

The harrowing experience was the last time Amyot used see one, do one, teach one. “It was eye-opening,” says Amyot, who speaks fluent French and pretty good English. “There should be a surrogate between reading in a textbook and performing on real patients.”

Amyot soon formed a business, Vimedix, Virtual Medical Imaging Training Systems. That became the surrogate. Vimedix developed the first commercial training simulator for transthoracic echocardiography, and the simulator is now used in dozens of medical centers, from the Mayo Clinic to Massachusetts General Hospital. The product was so successful that by 2010 Amyot quit practicing medicine to focus on a health care business career.

Now another challenge awaits Amyot: In April he was named president of CAE Healthcare in Sarasota. The business is a division of Montreal-based CAE, a $2.11 billion global civil aviation simulation and defense training firm. CAE Healthcare bought Amyot's Vimedix in 2010.

Amyot recently relocated to Sarasota, where he runs CAE Healthcare from its 76,000-square-foot facility just east of Interstate 75 off Bee Ridge Road. In a promotion from chief medical officer to president, Amyot replaces Mike Bernstein, who ran the business since 2009, when it was Medical Education Technologies, or METI. Bernstein, who helped facilitate CAE's $130 million acquisition of METI in August 2011, returned to a career in private equity.

“Robert brings a tremendous amount of credibility to the leadership of CAE Healthcare,” says Howard Fried, global manager of strategic relationships at CAE Healthcare. “He's not the kind of president of a global business who you will find in an ivory tower.”

With 140 employees in Sarasota and 200 total, CAE Healthcare manufactures, markets and sells a line of lifelike human patient and surgical simulators for use in medical training and education. It does that for a variety of medical disciplines, from maternity to wound care. It's an anomaly in the fragmented health care training simulators market, which has many small firms and few large ones.

CAE Healthcare has clients in more than 60 countries, and around 7,000 of its simulators are in use by medical schools, hospitals and military units. It has its own training academy, where a group of full-time clinicians provides peer-to-peer education and support for clients. Amyot, once a member of the CAE Academy, calls the learning unit one of CAE Healthcare's “unique and defining” assets.

With its products, academy and wide global reach, CAE Healthcare is like the Starbucks of its domain. That's a challenge and an opportunity to Amyot. “No one else can say they have all what we have under one roof,” Amyot says. “That's very unique in this market (so) a lot of attention is paid to what we do. It keeps us on our toes.”

More than crumbs
This is CAE's second attempt to build a big global business in health care technology. The company tried once before in the mid-1990s, but the effort petered out from low demand for medical simulation and training. Executives are more optimistic this time under Amyot, Fried and several other leaders, in combination with the systems and processes Bernstein implemented.

Medical simulation sales, overall, are crumbs to CAE, which makes most of its money in flight simulators for commercial airlines worldwide, including Air Canada and Scandinavian Airlines. Profits at the civil division, for example, increased 32% in the 2014 first quarter over the same period in 2013, according to public filings. “The growth in our first quarter operating results came entirely from civil,” CAE President and CEO Marc Parent says in an Aug. 13 earnings release.

But while the now is small, the growth potential for health care is significant. The parent company even recently put its mining unit up for sale to focus on three divisions: civil aviation, defense and health care.

One part of the health care strategy, says Amyot, is to better connect the Sarasota headquarters of CAE Healthcare with what he calls the mother ship in Montreal. “There are a lot of good practices and technology there that can work with health care,” Amyot says.

CAE Healthcare has also expanded its international sales force in the past few months in anticipation of a business surge in places like the Middle East and Asia. While METI had clients outside the U.S., most of its sales, says Fried, were domestic. “International sales are our fastest growing segment,” Amyot says. “We are signing on new distributors in countries where we were previously not represented.”

Another step in the strategy, executives say, is to speed up a shift at CAE Healthcare from a product-based sales approach to solution and consultation-based sales. The firm aims to sell products, then create training programs and other initiatives to raise its revenues per client.

“We want to be seen as more than a technology company,” says Fried. “We want to be a broad, one-stop shop. We don't want to be car salesmen.”

The sales philosophy shift is tightly connected to several new product lines. One in particular executives are excited about is a childbirth simulator with proprietary physiological modeling. The first commercialized high-fidelity childbirth simulator, it uses the same circuit boards that power CAE's flight simulators. Amyot says it's been tested through more than 120,000 births without failure. 

Stay nimble
Amyot also spends time on CAE Healthcare's big picture and long-term vision. “As technology reshapes medicine, we need to stay ahead of the curve and competition,” he says. “We need to be agile and responsive.”

A nimble business was how it all started, when Sarasota entrepreneur Lou Oberndorf, an Air Force pilot and Vietnam Veteran, founded Medical Education Technologies in 1996. Oberndorf launched the business with $500,000 and five employees. Sales grew rapidly in the early 2000s, and in 2006 Oberndorf sold METI to L-3 Communications. In 2008, when the firm did $63 million in sales, Oberndorf and some private equity investors, including Bernstein, bought the firm back.

Oberndorf later handed over day-to-day leadership of the business to Bernstein, who helped put together the deal with CAE. Bernstein began to groom Amyot for a larger leadership role earlier this year.
For a division head of a large global business, Amyot has an entrepreneurial, just-get-it-done bent. He considers himself a pragmatic leader, not a dogmatic one. He strives for a flat organization, one not weighed down with leadership layers.

That philosophy dates back to Amyot's grandfather, also a physician. Robert Amyot lived with his grandparents when he was a young boy in Montreal. The entire Amyot family actually lived on the second floor of the building, while the grandfather ran his medical practice on the first floor. Robert Amyot especially remembers how his grandfather, a doctor from 1926-1976, put medicine over the bureaucracy and treated many lower-income patients.

“Being a physician to him wasn't only being a clinician,” he says. “It was more of a holistic, global approach.”

Amyot leans on lessons he learned from his grandfather in his new role at CAE. One lesson is to constantly figure out ways to do more for clients, like his grandfather did for patients. That will help both CAE Healthcare's customers, says Amyot, and improve the unit's already formidable market share. “We are a reference in the market,” says Amyot. “We are the one to beat.”

Executive Summary
Company. CAE Healthcare Industry. Health care, technology Key. Company seeks to expand global client base.

At a glance
Company: CAE
Headquarters: Montreal
Year founded: 1947
CEO: Marc Parent
Fiscal 2014 revenues: $2.11 billion
2014 net profit margin: 9.04%
Market capitalization: $3.25 billion
Recent share price: $12.28
Employees: 8,000 (140 at CAE Healthcare in Sarasota)
Divisions: civil aviation, defense and health care
Products and services: Includes more than 1,000 kinds of flight simulators; an aviation academy; software for military aircraft; and highly realistic medical patient simulators. Customers are in nearly 200 countries.
Sources: Google Finance, CAE