What if I told you that success for your startup doesn’t require competing with the big orthos on their terms with their well-oiled systems of service, inventory management, training and marketing?
What if all you needed were 25 loyal customers to build a profitable and defendable business in an orthopedic niche?
For niche examples, think market segments like F/A soft tissue repair (Artelon) or 2-stage joint revisions (OsteoRemedies) or patella fracture repair (Endeavor Orthopedics) or single-use endoscopes (Pristine Surgical) or real-time monitoring of compartment syndrone with a disposable (IMY01). I could go on and on here with niche examples, but you know these types of ortho companies.
This idea isn’t as far-fetched as it seems.
How the Math Works
You have developed a specialized implant or instrument that solves a real problem for both surgeons and healthcare providers. Terrific! It saves them time, saves them labor, enables hospitals/ASCs to do more cases with better outcomes. You price it competitively, and your new customers see the value.
- Revenue Per Customer: Let’s say each of your loyal customers generates an average of $20,000 weekly sales. That’s $80,000 per month or $1M per year. Very doable.
- Revenue Per Year: With 25 loyal customers, you’re generating $25 million annually.
- Expenses: By focusing in on 25 loyal customers instead of thousands of potential customers, you need less implant inventory, less rep service, less surgical training courses, less travel, less contracts, less employees, and basically less of everything. You can do with with less than 10 employees. Your total expenses (including payroll, sales commissions, inventory, lease, insurance, R&D, marketing, legal training) should not exceed $10M per year.
- Profit: Now you have successfully built a sustainable business with a manageable number of customers who love your product, love your company, and you are netting a $15M annual profit ($25M gross revenue – $10M expenses).
The Pareto principle (the 80/20 rule) is your friend when choosing customers. Leveraging this philosophy, the need to chase hundreds or thousands of accounts becomes unnecessary. No more market expansion. No more medical conferences.
Instead, you can focus on building deep relationships with a smaller, loyal base. Your 25 most loyal customers.
A New Playbook for Startups
The 25-customer philosophy is a call to rethink what success looks like in orthopedics. It’s not about trying to unseat the giants or capture massive market share. Instead, it’s about creating deep value for a small number of customers who will stick with you for the long haul.
By focusing on your 25, you can build a thriving, sustainable business that stays true to your mission and delivers real impact. Success isn’t about scale—it’s about loyalty, relationships, and serving your niche better than anyone else.
Tiger Buford is an industry veteran, startup advisor, and founder of OrthoStreams, where he shares unvarnished insights on orthopedic innovation. Follow Tiger for more ideas on how to disrupt and thrive in orthopedics here – https://linktr.ee/tigerbuford