It’s time to stand up! Hey, we’re all working from home and you can do this now.

Odds are, you are probably sitting while reading this and you know that sitting most of your day is not healthy.

We have all heard that “sitting is the new smoking”. You may have read the NY Times article, “Is Sitting a Lethal Activity?

Sitting down is unnatural. Excessive sitting increases your chances for cancer, heart disease, obesity, type-2 diabetes and depression. I don’t have to preach to my orthopedic friends about sitting.

So, I believe that the best solution is to convert your low workspace to a standing workspace. The benefits are real. I found that I burned more calories, increased my good cholesterol, lost weight, slept better and generally felt better each day. As a side effect, I found that I was also more productive each day.

Here are tips on how I made the transition to a standing desk in 3 Steps.

Step 1 — Experiment First!

I strongly advise you to experiment with standing first with a simple DIY temporary setup. Don’t spend a lot of time or money for a permanent arrangement until you can stand for three-to-four hours each day. You can do a lot with bricks or cinder blocks. You can raise your entire desk with blocks underneath, or add blocks on top and place a door on top. Anything will work if the dimensions are right.

The same way that moths are attracted to light, Engineers are attracted to cool technology.

That’s just how we are built. I’m a trained Engineer too. We are all attracted to cool technology. It’s tempting to always seek out a new company with interesting technology.

When I started out in orthopedics, engineering was 100% mechanical. Today, the combination tech in orthopedics can be a mixture of many engineering disciplines — Mechanical + Electrical + Software + Optics + Mechatronics + Haptics + Robotics. There is some really cool tech out there now.

Here is my simple advice for you.

Don’t chase tech for your best career move.

If you have multiple new job opportunities, choose the one with the most empowering culture and best management team.

You should chase empowering cultures first, even if the technology doesn’t look that great. Forget about the cool tech. Empowering cultures, particularly in startups, will boost your career.

Read more about the 7 real benefits of working in a startup.

Today, I am sharing 30 lessons for emerging orthopedic companies.

I love to help my friends in the smaller ortho cultures, so I collected these 30 lessons over 30 years of experience.

These lessons are timeless. For easy digestion, I have broken the lessons into a categories:

At the Beginning — Lessons #1–5
Business Execution — Lessons #6–20
People — Lessons #21–27
Money — Lessons #28–30

Enjoy and share the link with your ortho friends —


Today I am sharing five red flags to avoid for your next key hire in your growing Orthopedics company. I have seen all five of these mistakes. Send me a note if you have seen this also.

#1 — Don’t hire the person running away from a bad situation, a bad boss, an ethical disagreement, etc.

#2 — Don’t hire the person who thinks he/she is vastly underpaid.

#3 — Don’t hire the person just because he/she wants to live in your city because of family or a boyfriend/girlfriend there.

#4 — Don’t hire the person who shows a lack of interest in your business.

#5 — Don’t hire the person just because he/she is your friend.

Do… hire this person.

A “Sacred Cow” is a firmly held belief that is rarely questioned and is exempt from criticism or opposition in an industry. Every industry has its “Sacred Cows”.

Sacred Cows create blind spots that can kill companies.

Example: In the photography world, we all watched the market leader in photography fall victim to the Sacred Cow mindset.

I hear this request often. Ortho executives call and say… “I need an Engineer”.

This is the wrong question… an Engineer is not an Engineer.

Many Ortho leaders have a tendency to jump to the solution. This is completely normal. We all do it. We have a budget slot for an Engineer so you want someone with that title.

Think about it differently… What problem are you trying to solve?

Instead of filling a on Engineering chair, you may actually need…

  • a predictable pipeline of new products
  • more creativity or the ability to solve a specific engineering problem
  • someone who can convert a specific surgeon’s ideas into new products
  • a leader who is a great interface between marketing, sales and surgeons
  • an organized and detail-oriented project leader for an especially large new project
  • a coach/mentor for the younger engineers.

Not all Engineers are the same. Just because people have the same degree doesn’t mean they have the same skillsets and will perform the same inside your company.

So when contacting me, tell me what problem you are trying to solve and I will bring you the individual that solves your problem.







First, in your 20’s, to learn.

You are a sponge. Your goal is to learn, take on new challenges, hustle and make mistakes. Absorb all aspects of the business. Have lunch with anyone who will say “yes” (we all eat lunch). At this stage in your career, your advantage is time because you don’t know anything yet. The entrepreneurial spirit from the leaders will rub off on you. You have no meaningful financial equity, but you will learn, and this is your equity. You will discover yourself, what interests you and what your strengths are.

Second, in your 40’s, to earn.

Now, you have the experience and skills to lead or join a startup and make the startup successful. Do it. Your super-power is your experience combined with your energy and drive. Go all in. Grow the startup and make it successful. Then reap the benefits of the valuation growth with either an IPO or buyout. Cash out without regret.

Third, in your 60’s, to give back.

You don’t have the desire or energy to do it again, and you have already made your money. Now, you can mentor others. Your super-power is your vast experience and perspective. Younger startup leaders will cherish your advice. You can contribute through board positions, consulting, pro bono work, or volunteering at the medtech incubator in your region. This will be your most rewarding startup work.

Tell me your story ?

Ortho Blog:




If you want to eliminate yourself from opportunities in the startup world, do these 10 things.

  1. Hang in there at your current company for that next promotion that has been promised. You can get it. You might very well outlast everyone and get that promotion.
  2. Get more degrees, perhaps an MBA, and have your employer to pay for it. This will create a financial dependency with your employer.
  3. If an opportunity for a phone interview doesn’t sound good, just pass on it.
  4. Don’t do anything crazy to mess up your spouse’s job. Always be thinking about your spouse’s career also.
  5. If you are really interested in joining a small company, wait until the startup has strong…

Each startup comes to life with specific strengths and weaknesses. No orthopedic startup is perfect. The strengths are great assets in the early years. However, if weaknesses are not addressed early, they can become a “weak link” that can stymy growth.

Think about it. Why do some startups:

– reach profitability quickly, while others burn cash indefinitely?

– run a smooth operation like a Swiss watch, while others live in chaos?

– have a great product, but cannot seem to gain sales traction?

The Founder Effect

The Founder is the person who starts the business and typically leads the business in the beginning. The Founders strengths are the Founders weaknesses.

The thesis of this article is… The training and background of the Founder determines both the strengths and “weak links” of the company in the early years.

This opinion is derived from decades of pattern recognition following hundreds of orthopedic startups. The Founder only knows what the Founder knows.
Below, I’m going to share the patterns that I see for each type of Founder. Please don’t take the examples literally. I’m talking about general tendencies, not specific companies.

Let’s jump in.

7 Founder Backgrounds

#1 — Founder has a SALES/MARKETING background, usually either an Independent Distributor or a Marketing executive from an organized orthopedic company.

Strengths: Closeness to the customer. Know how to build the distribution model. Practical understanding of what the customer needs. Strong messaging.

Weak Link: Unrealistic expectations for cash burn rate and timelines for Product Development, Regulatory, Operations. Poor understanding of manufacturing and timelines to make the product. Sales/Marketing Founders tend to build operational systems late in the game.

My Advice: Hire strong operational leaders early.

Examples: Choice Spine, Degen Medical, Osseus, 4WEB, OsteoRemedies, ExtraOrtho, In2Bones, Soteira, Danek Medical.

#2 — Founder has a CLINICAL background, usually as an orthopedic surgeon working in a full-time practice.

Strengths: Closeness to the customer. Solving real clinical problems.

Weak Link: Unrealistic expectations of funding and timelines for Product Development, Regulatory, Operations and Sales. Also surgeon founders are sometime driven first by trying to impress their MD colleagues. Most want to continue their full-time practice.

My Advice: Hire a CEO early with operational expertise to lead the company.

Examples: Exactech, Hand Innovations, Intellirod Spine, Titan Spine, MiRus, Micro-C, Aptis Medical, NuOrtho Surgical.

#3 — Founder has a TECHNICAL background, usually as an Engineer within a startup or an organized orthopedic company.

Strengths: Product development, product detail and systems.

Weak Link: Sales & distribution. “What does the customer want and what is he willing to pay for?” Sometimes ego of founder.

My Advice: Hire a Marketing pro early, then hire a Sales pro 9–12 months before commercialization.

Examples: Theken Spine, NextStep, Regeneration Technologies (RTI), NovApproach Spine, Mission Surgical, Amedica.

#4 — Founder is an INVENTOR on a Class III device pathway.

Strengths: Cahones. Thinking big to carve out a huge regulatory barrier to entry against potential competitors. Not afraid of risk.

Weak Link: Long haul fund-raising. Time to market can be 10 years. “Are investors willing to wait that long?”

My Advice: Hire strong Clinical and Regulatory leaders with street smarts.

Examples: Intrinsic Therapeutics, Active Implants, Surgical Dynamics.

#5 — Founder is an INVENTOR on a Class II device pathway.

Strengths: IP protection of product.

Weak Link: Unrealistic expectations of product and market acceptance. “Everyone will love my idea once it’s a product”.

My Advice: Hire proven Engineering Management and a Marketing pro early.

Examples: Spine Wave, Ellipse Technologies, TranS1.

#6 — Founder has a FINANCE background.

Strengths: Cost control, maintaining profitability, and avoiding the need for outside funding.

Weak Link: Lack of closeness to the customer, taking risks with new technologies, low R&D investment.

My Advice: Hire strong Sales and Marketing pros early.

Example: Wenzel Spine

#7 — Founders are a TEAM, usually a collection of 2–5 individuals with diverse orthopedic backgrounds.

Strengths: Ability to listen to the customer, validate the market need and deliver what the customer needs in a timely way.

Weak Link: Alignment. Pushing and pulling in different directions. Founders, investors and key personnel can lose sight of shared goals.

My Advice: CEO must over-communicate and continually review the company’s collective objectives.

Example: OrthoHelix.

What is your experience with Orthopedic startup founders?


My contact info:

Ortho Blog:




“Why is my New Product Development pipeline too slow, too expensive and lacking innovation?”

I get this question from frustrated leaders in the larger Orthopedic companies. I thought I would share the formulas to the OrthoStreams community that have worked for me. Here are 10 specific rules you can use to help your R&D teams execute at a higher level.

Note: these rules are for the larger orthopedic companies, not startups.

Tiger’s 10 Rules

Rule #1 — Match team strength to project complexity
I often see too little horsepower for big strategic product development, which leads to projects that go nowhere. Draw a matrix, and put all of your projects into one of the four quadrants (Complex or “Me too” by Line Addition or Strategic)

The rule of thumb is:

  • “Light Weight” Teams are suited for projects that are both “me too” products + line addition
  • “Medium Weight” Teams are suited for projects that are complex, but only a line addition
  • “Medium Weight”…

Tiger Buford

⭐️Retained Recruiter for emerging Orthopedic companies and startups — industry insider, super-networker, startup thought leader, blogger, podcaster.

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