Do you love nebulous situations? Do you like completely owning problems?

Startup Career summary

Working at a startup can vary more than any other job. There are many factors that determine what a job at a startup will look like, such as size, stage, and role. But regardless of those factors you can be assured that most of the time working at a startup will have you wearing more hats and learning more quickly than any other job.

Primary US City locations

Most opportunities are in SF, NYC, and Boston, but opportunities could be found anywhere

Unique factors for startups

At startups there are a couple unique factors that are important to consider and can be highly variable. Two of these factors are the stage of the startup and whether you are founding a startup or joining one. The stage of the startup will likely determine how much equity you get as payment, how big of a risk you are taking by being paid in equity, how many employees the company has, and how many different roles you will be asked to fill. Additionally, founders have a much different role than people who are joining a startup. Founders have to worry about fundraising and pitching to investors, while also making sure the company is headed in the right direction.

Because startups are so variable (much more so than any of the other options I have written about) I would strongly encourage anyone who is interested in joining a startup to do research into a wide range of aspects. Some of these include making sure you know what stage of company you want to join, how to evaluate if a startup is has a good chance of becoming a rocket ship or a dud (or at least how to get a feel for that, no one can predict it!), what it means to be paid in equity and all of the (many) minute details of that, and more. I have written up a more detailed guide and posted it on GitHub:

Summary of the role

The day to day job at a startup can look very different depending on the company and the role. As a medical doctor you will be the medical expert and it is likely that you will be giving advice or thinking through problems from that lens. You would have unique insight into which aspects of a product that medical professionals would use or trust, and which ones would make the most sense to prioritize. You are essentially leveraging your experience in a way that benefits the company.

In addition, you can be asked to do things that are tangential to the medical field. If there is a question about FDA regulations, then you might be asked to learn about the relevant laws enough to give a presentation – or help the company understand billing in the medical system. For issues like these, you might not be knowledgeable yet but you should trust in your ability to learn complicated things and lean on your medical knowledge – that already will put you ahead of many people.


The salary at startups is dependent on the amount of fundraising the company has done so far. Late stage companies can pay similar to big tech (~$160,000) and will offer small amounts of equity (~0.25% per year). Early stage companies, on the other hand, often can’t afford to pay large salaries and will offset this with larger equity packages. These packages are highly variable and are a combination of (usually below market level) cash and (potentially very significant) equity - an example could look like ~$100,000 per year and ~2% of the company. Obviously 2% of a company is highly dependent on the value of the company, and while it would be fantastic to receive 2% of the next Google or Facebook, startups (especially early stage) have a high rate of failing, and "unicorn status" ($1B+ valuation) is is the exception and not the rule.

Work / life balance

Most startups are resource deficient, and so they will be trying to do as much as possible while using the least amount of resources. This means that the company might be asking a lot from all of their employees. Additionally, startups are trying to grow and are routinely encountering new problems. If the problem that is encountered is time-sensitive, then the person who is solving that problem might need to work longer hours to solve it.

Conversely, startups want to retain the talent they have (as it is expensive to replace), so startups often implement fantastic time-off and work-from-home benefits as soon as possible.

Progression and Exit Opportunities

The main benefit of startups is that you will be given a larger-than-normal level of responsibility and you have the potential to grow at a faster-than-normal rate. If you excel and the company succeeds then this can put you in a fantastic opportunity at a stage of your career that would normally not be possible. On the other side, if the startup fails you will have likely learned valuable lessons that another company will value. Either way, you are likely taking on much larger and higher-impact roles at a startup than at any other company, and you will be able to leverage that fact. Going to a start up is a fantastic way to get experience in founding, if you want to be an entrepreneur in the future, or in working at startups. Many startups want to hire people who know what they are getting into and can bring a high level of experience, which is only possible after working at a startup!

Medical specialty analogy

A Med/Peds resident who then did Peds-Onc fellowship and gets half their salary in lottery tickets. You need to be smart and impressive to get the job, then the job is a lot of hard work, and the salary is lower than other people who do similar jobs (the case of all peds specialists ☹) but you get paid in equity*!

*which is usually worthless because the majority of startups fail.