Where do you work?

I talk with orthopedic leaders each week.

I can tell the difference between a Startup Leader versus a Big Company Leader within 60-seconds. 

The contrast in cultures always amazes me.

The leaders of Big Orthos rely on people who don’t make mistakes and follow instructions directed from the top. Management and employees must fit within their framework. The result is safe product designs, by-the-book quality and regulatory processes, large scale production, attention to compliance, old school selling techniques, and traditional marketing that protects the brand. Big Orthos have built a complex network of processes and machinery that supports their large volume transactions. The leaders of Big Orthos have people with titles like – Area Southeast Sales Director for Thoracic, Reimbursement Manager, Global Anti-Corruption and Investigations Counsel, Contract Negotiator, CAPA specialist, Financial Analyst, and Biostatistician.

This network is not nimble. The people are not nimble. Individuals who work inside Big Ortho have lost their ability to make critical decisions about new projects, acquisitions, or new initiatives without upsetting the machine. If an individual wants to try something new, they have to get permission up the chain of command. The answer is usually no.

Unfortunately, this is the way that Big Ortho must function because they focus on earnings every 90 days at any cost, thwarting any real innovation. They have become a slave to the financial numbers. Leaders protect the machine and management protects their status. I really feel sorry for these Leaders. They are good people who are stuck in the endless shareholder earnings cycle.


The leaders of Startup Orthos rely on people who take chances and solve problems in creative ways within the limited means of the company. The result is entrepreneurial work. The titles are simple – Head of Sales, Head of Marketing, Head of Quality, Head of Product Development. There are only 2 layers – professionals and hands-on working Dirs/VPs. 

This startup culture is incredibly nimble. A startup can change business models or product focus in one meeting. The organization has little structure and few processes. Individuals can make material decisions about most things. Individuals have a lot of rope. This is the way startups must function because they focus on disruptive innovation and taking risks within limited budgets. They ultimately win by taking the right risks at the right time and executing. 


What environment do you work in?