ARTICLE · Medtech

How to Build a Medtech Company That Scales

Org design, ownership boundaries and platform logic for a manufacturer of prosthetics and orthotics

Nikita Nechaev · April 2026

The global medical device market reached $587B in 2023. Within it, the prosthetics and orthotics segment is worth $7–8B, with growth projected to $13B by 2028. The numbers look impressive. But they hide a paradox: only a small share of those who need it worldwide have real access to prosthetics, and in Russia the availability of prosthetics providers is markedly lower than in the developed economies of Europe.

This gap between market size and access to care is not merely a social problem. It is a business opportunity for a new kind of company — not just a device manufacturer, but a platform that connects the prosthetic, the data, rehabilitation and the clinic into a single system. But for such a company not to remain a garage startup, it needs the right organizational design from day one.

Why the classic structure fails in medtech

Most Russian medical device manufacturers are organized along functional lines: an R&D department, a production department, a sales department, accounting. This model works well for a company that ships one product to one market. But once several product lines, a digital platform and international expansion appear, the functional setup starts to drag.

In our experience, few organizations succeed at building effective performance-management processes. The cause is rigid hierarchies in which accountability dissolves between departments. When research and development (R&D), marketing, sales and regulatory affairs are all responsible for launching a new prosthetic, in practice no one is.

The alternative here is organizations built around micro-cultures: autonomous teams with their own norms, but accountable to shared goals. As a rule, these are the ones that achieve positive business outcomes markedly more often.

Product units instead of departments

The model better suited to a medtech company with platform ambition is product-centric with a shared platform core. This means each product line becomes an autonomous unit owning its own results, while the platform is the shared infrastructure the units draw on.

This principle is clear in practice: companies that move from broad product strategies to a systematic approach with clear business-unit boundaries tend to lift shareholder returns markedly. And conversely, a blurred sense of business boundaries leads to investment in knowingly loss-making directions.

In our case this means three product units tied to three customer segments:

The first unit — high-functionality prosthetics for working-age people with lower-limb amputations. This is the anchor product that generates the core data for the AI platform and sets the quality standard.

The second unit — affordable 3D-printed prosthetics for developing markets and government rehabilitation programs. Three-to-five times cheaper than conventional ones, mass reach, a network effect for the platform.

The third unit — orthotics and assistive devices for older patients (65+). The population is aging fast, and demand for orthotics and assistive devices for older patients will only grow. In Russia, as in most developed countries, the share of older citizens is steadily rising.

Each unit is led by a product lead with full accountability for the P&L of their line. Not a "task manager," but an entrepreneur inside the company. In our experience, successful career moves and income growth are most often tied to ownership of the end result, not the process.

The platform team: not an IT department, but the core of the business

Separate from the product units sits the platform team. Its job is to build and maintain the digital infrastructure every unit uses: the patient profile, the device's digital twin, the AI engine for fitting and adaptation, the tele-rehabilitation module, the SaaS product for clinics.

Why is this not simply an "IT department"? The platform approach in commercial medicine shows that revenue and margins grow faster when the technology platform becomes the core of the business rather than a supporting "IT department." The EV/EBITDA multiple of platform companies is considerably higher than that of traditional clinics.

The experience of platform companies shows that those who ignore the ecosystem approach risk losing customer relationships, while those who build the platform right capture a tangible revenue uplift. The key condition is a clear understanding of roles: who owns the data, who builds the product, who engages with the customer.

That is why the platform team has its own KPIs: system uptime, the pace of adoption by clinics, data quality, the accuracy of AI recommendations. It is an equal business unit, not a service function.

The staffing model: 18 people at launch, AI as a multiplier

One of the most frequent questions: how many people do you need? The answer is set by two factors — the talent shortage and the capabilities of AI.

Today most companies worldwide feel a talent crunch one way or another, and over time the working-age population in many countries will shrink. In medtech the situation is even sharper: the shortage of qualified healthcare workers is felt especially keenly.

But there is a counterweight. In our experience, generative AI can meaningfully offset the talent shortage and raise productivity. It speeds up software releases and reduces the need to hire for routine entry-level roles, while the value of mid-level specialists, by contrast, rises.

This means that at launch 18 people are enough — provided each one uses AI as a multiplier. The CTO writes code with an AI assistant, the VP Sales uses AI for outreach and lead qualification, the Product Lead — for data analysis and hypothesis generation.

The headcount model scales with the roadmap: 35 people in year two, when the affordable-prosthetics line and the SaaS for clinics are added. 60 people in year three, when the line for older patients appears and entry into CIS markets begins. 100–150 by year five, including international offices.

Managers are the bottleneck, not a shortage of engineers

An unobvious fact surfaces here: in many companies managers are not ready to lead through constant change. Yet a strong manager noticeably raises the productivity of their team.

This is the medtech company's paradox: finding a prosthetics design engineer is hard, but finding a product lead who simultaneously understands the clinic, can run a P&L and speaks the developers' language is harder still. That is exactly why the org design builds in a "grow from within" principle: career tracks inside the units, rotation every 12–18 months, mentorship from senior leadership.

From what we observe, many Russian companies lack mature career-management practices, even though they use internal hiring fairly widely. The barrier is formalities, not a lack of potential. A company that removes these barriers gains a competitive edge in a market where everyone is fighting over the same people.

Culture as infrastructure, not a slogan

The final element of org design, often regarded as "soft" yet determining everything else, is culture.

Experience reveals patterns that are hard to ignore: employees who feel inspired at work are far more likely to recommend the company as an employer, and in inclusive teams people are markedly more likely to feel they matter. These are not abstract metrics — they are a direct driver of hiring and retention amid a talent shortage.

At the same time, many HR leaders do not know how to build culture in hybrid and distributed work. For a medtech company, where part of the team is in the lab, part on the production floor, and part working remotely, this is a critical question.

We build in four principles. The first — owner mentality: every product lead is an entrepreneur with P&L accountability. The second — AI-first operations: AI is built into every process, but with a focus on the human dimension. At the same time, a significant share of people still do not trust AI systems, so success is determined not by technology but by change management. The third — radical transparency of metrics. The fourth — growth from within: an engineer today, a product lead tomorrow, a VP in three years.

What this means for the industry

Russian medtech is growing: sector companies' revenue is rising steadily and the use of AI is expanding fast. The commercial medicine market remains large and continues to grow, yet it is still heavily fragmented — the share of large players is small.

This is a market awaiting a consolidator. But consolidation in medtech does not happen through acquisitions — it happens through a platform that clinics, rehabilitation centers and insurers plug into. And a platform works only when behind it stands an organization designed for scale: with autonomous units, clear ownership boundaries, AI-amplified teams and a culture that attracts talent.

Medtech is not software. Here you cannot ship an MVP in two weeks and watch the metrics. Certification takes months, clinical data accumulates over years, the trust of physicians is earned over decades. That is precisely why organizational design matters more than the product: the right structure creates the conditions in which the right product emerges inevitably.