3 Filters That Separate Breakthrough Devices from Failed Ventures

Key Learnings From Josh's Experience

• 3 filters for clarity on whether your device matters. Since the 2008 financial crisis, devices that thrive meet at least one of three tests: they fundamentally change how care is delivered, improve cost efficiency, or drive a substantial leap in outcomes or safety. Purpose-built devices designed against those criteria succeed; “orphan” technologies pulled from university labs rarely do. At Tulavi, that discipline kept the team focused on neuroma prevention and shaped everything from product design to commercial strategy.

  
  

• Lean into the harder regulatory path when it builds a moat. Shortcuts may get you to market faster, but they rarely create lasting advantages. Tulavi chose the de novo pathway, which meant tougher regulatory requirements but also positioned the allay Hydrogel Cap as the first of its kind. The payoff: FDA wrote new regulations specifically for their category, forcing future competitors to meet the same evidentiary bar. As Josh puts it, sometimes the more challenging path delivers the strongest protection.

  
  

• Match your pitch to the investor in front of you. Angels invest in people — they back entrepreneurs through relationships, warm introductions, and trust. VCs, on the other hand, triangulate price, exit probability, team, and market opportunity with a sharper eye for scalability. The pitch mechanics may look the same, but the decision-making lens is different.

In medical training, physicians learn to own every aspect of patient care — master the knowledge, make the decisions, take full responsibility. You're trained to be the expert on everything that touches your patient, from complex diagnoses to treatment protocols. It's a mindset that saves lives in the OR but can kill startups in the boardroom.

Josh Vose learned this lesson early in his transition from surgeon to serial entrepreneur. The same "total ownership" mentality that made him an effective physician could create dangerous blind spots when developing medical devices. "Physicians may treat developing a device similarly, that you have to be the expert on all domains of development," he explains. "That is not the case. You need to surround yourself early and aggressively with people who know more than you do."

It's a lesson that took years to internalize — and one that countless physician entrepreneurs still get wrong. They spend months writing their own patents, trying to master regulatory pathways, or attempting to become manufacturing experts. Meanwhile, their most precious resource — time — slips away. "You just simply can't learn it all yourself," Josh says. "The older I get, the more I realize the limitations of my own knowledge."

After multiple successful exits spanning nearly two decades — including PEAK Surgical's acquisition by Medtronic and SIA's by Integra — Josh has honed his approach at Tulavi, where he leads the development and commercialization of the allay Hydrogel Cap for preventing neuroma formation. The results reflect his hard-won understanding of what separates successful device companies from those that never make it to market: while most novel medtech companies fight tooth and nail to capture market share, Tulavi is seeing remarkably fast adoption across health systems.