Cruxx

The Bay Area’s MedTech Talent Dilemma in Cardiology & Surgical Innovation If you’re building devices in cardiology or surgery right now, you’ve probably felt it: hiring in the Bay Area is getting brutal. Between Big Tech poaching engineers, the cost of living, and the intense R&D complexity of regulated medical devices, it’s never been harder to attract (and keep) great people. Here’s what’s really happening 👇 The Market in Numbers 📊 The U.S. medical device workforce tops 500,000, but according to Deloitte, three out of four medtech companies say they are struggling fill critical technical and clinical roles, especially in software-driven cardiovascular and surgical systems. Roles in R&D, regulatory, and software/firmware engineering are now open an average of 90+ days in the Bay Area, nearly double the national average for medtech. Cardiology devices funding hit $6.2B in 2024, up nearly 30% from pre-pandemic levels (PitchBook). Yet companies say talent availability is now the #1 bottleneck to scaling clinical and commercial programs. The average senior design engineer in surgical robotics commands ~$180–200K total comp in the Bay Area and that’s if you can find one who isnt in 3 other processes. Many are being lured into adjacent fields like robotics for warehouse automation or AI-enabled imaging. Why It’s Tougher for Cardio & Surgical Companies Tech’s Talent Drain - The same systems, mechatronics, and software engineers needed for robotics and catheter-based systems are being courted by AI startups, EV companies, and aerospace. Big Tech offers stock, remote flexibility, and instant brand clout; tough competition for regulated startups grinding through FDA milestones. Clinical Complexity = Hiring Hesitation - In cardiovascular and surgical devices, product lifecycles are longer, risk is higher, and cross-functional collaboration (R&D ↔ Clinical ↔ RA/QA) is essential. Many candidates prefer faster product cycles in digital health or diagnostics over 4–6 year PMA journeys. Cost of Living vs. Capital Efficiency - Bay Area engineers are 25–35% more expensive than their peers in Minneapolis or Boston. Even well-funded startups are shifting design and clinical teams elsewhere creating a “split culture” between HQ and operations. Experience Bottleneck - In cardiology, demand for engineers with catheterization, electrophysiology, PFA or implantable device experience has exploded. But those profiles are concentrated in legacy giants like Abbott, Boston Scientific, and Medtronic not early-stage companies. The irony? The U.S. is one of the most innovative regions in the world yet the next generation of life-saving devices may depend on whether we can bridge this talent gap before it becomes a growth gap.

Why is the UK falling behind in medical device innovation? Despite world-class universities, strong R&D talent, and a national health system that should, in theory, be a perfect testbed for new technology, the UK still struggles to bring medical device innovation from concept to clinic. Post-Brexit regulatory uncertainty, slow NHS adoption, limited funding for scale-ups, and a risk-averse culture are leaving promising MedTech ideas stuck in the lab while competitors abroad move ahead. Now dont get me wrong we have seen some incredible companies come to life out of the UK as of recent! But I would love to see more OrganOx, CMR Surgical and Ultromics appearing. 💡 This is exactly why we started The MedTech Club. What began as a simple idea to connect innovators facing these same hurdles has grown into a community of nearly 30 CEOs and Founders of medical device startups, all sharing experiences, challenges, and solutions to push UK MedTech forward. We’ve already hosted sessions on fundraising, market access, reimbursement, and managing strategic relationships, and the insights shared have been invaluable. But we’re not stopping there, we’re now looking to welcome a few final founding members to join the cohort and help shape the next phase of this journey together. If you’re leading a MedTech startup or know someone who is and wants to be part of this peer-to-peer network, drop me a message.

𝐓𝐡𝐞 𝐆𝐞𝐧𝐝𝐞𝐫 𝐆𝐚𝐩 𝐢𝐧 𝐂𝐚𝐫𝐝𝐢𝐨𝐥𝐨𝐠𝐲 𝐚𝐧𝐝 𝐖𝐡𝐲 𝐈𝐭 𝐒𝐭𝐢𝐥𝐥 𝐌𝐚𝐭𝐭𝐞𝐫𝐬   𝑯𝒆𝒂𝒓𝒕 𝒅𝒊𝒔𝒆𝒂𝒔𝒆 𝒊𝒔 𝒕𝒉𝒆 𝒍𝒆𝒂𝒅𝒊𝒏𝒈 𝒄𝒂𝒖𝒔𝒆 𝒐𝒇 𝒅𝒆𝒂𝒕𝒉 𝒇𝒐𝒓 𝒘𝒐𝒎𝒆𝒏, yet women still make up less than one-third of participants in many cardiovascular trials.   That imbalance isn’t just a statistic, it’s a real problem that shapes how they diagnose, treat, and even understand heart disease.   Women often experience different symptoms, different risk factors, and different responses to therapy. But most of the data, devices, and diagnostics were built around men. A few examples really highlight how much we still have to learn:   - In heart failure, women actually showed greater benefit from Sacubitril/Valsartan than men, even though most of those trials were male-dominated. - Reviews of heart failure RCTs show many still don’t report sex-specific outcomes at all. - Imaging studies have found that women’s coronary arteries tend to be smaller and follow different flow patterns, which may change how disease develops. - In acute coronary syndrome, machine learning has shown that the top predictors of mortality differ by sex. Things like kidney function and heart rate play a bigger role for women. - And then there’s the “Yentl Syndrome” where women are underdiagnosed because their symptoms don’t match the classic male presentation of a heart attack.   It’s not just about trials, though. Sex differences affect device design, diagnostic criteria, research funding, and even who gets a seat at the table in leadership and decision-making.   This isn’t about equality for the sake of it, this is about better science and safer outcomes for everyone

AtaCor Medical, Inc. just raised $75M to fund its pivotal U.S. trial for an extravascular ICD (EV-ICD) system, a device designed to protect patients from sudden cardiac arrest without putting hardware inside the heart or veins. For years, traditional ICDs have saved lives, but they’ve also come with baggage. Leads that run through the vasculature can fracture, get infected, or make future cardiac procedures complicated. Lead extraction alone is one of the more challenging procedures in electrophysiology and one that most patients would rather avoid. AtaCor’s system takes a different route. Instead of placing leads inside the heart, the device sits outside it but still delivering therapy through electrodes positioned under the chest wall. The idea is to keep all the therapeutic benefits of an ICD, but remove the long-term complications that come from being inside the body’s most delicate spaces. This new round of funding will support their ALARION EV pivotal study, building on positive early data from the ASCEND EV trial. If successful, this could mark a real turning point giving patients and physicians an alternative that’s safer, simpler, and less invasive. What an announcement and yet again signal of the momentum in the current cardiology climate. Truly excited to see where Rick, Alan and Maria can take the business and the impact it can have on extravascular care. #cardiology #extravascular #crm #cardiacrhythmmanagement

I somehow missed this one on Friday, but fantastic news coming out of AorticLab as they received FDA approval to begin a pivotal U.S. trial for their FLOWer Embolic Protection System, a device designed to protect the body from embolic debris during transcatheter heart procedures. For anyone familiar with these procedures, the risk of stroke or “silent” brain lesions caused by tiny fragments of debris has always been a major concern. FLOWer aims to tackle that challenge head-on by providing full-body protection, not just for the brain but for the entire systemic circulation. It’s already CE-marked in Europe and being used in real-world cases, but this pivotal trial marks a huge step toward U.S. approval. The study, led by Azeem Latib at Montefiore in New York, will be key in understanding not just the safety profile of the device, but how it performs in the complexities of real-life clinical practice. It’s easy to forget that every new device like this represents years of research, iteration, and persistence from engineers, clinicians, and innovators all working toward one simple goal: making cardiac interventions safer. This is one I’ll definitely be watching closely. Huge congratulations on the milestone Franco Osta, Enrico Pasquino and Marco Vola and as mentioned above to the wider team in Italy making it happen! Check out the full article from MassDevice in the comments below. #medicaldevices #cardiology #TAVR #FDA

Building a MedTech company is one of the if not the hardest business to build. That's why we've built The MedTech Club for founders & CEO's who are on the journey. It's a safe space, to network, learn, grow and develop with no judgement. If you're building in the UK send me a message, and if you're based outside of the UK in Europe or the US, send me a message to get on the waitlist for when we expand internationally.

The strength of the Cardiology market continues to show with an exciting update coming out The Twin Cities. FastWave Medical continues to push the boundaries in vascular innovation, announcing their co-Principal Investigators and steering committee for the pivotal U.S. IDE trial of the Artero peripheral electric IVL (E-IVL) system in treating PAD. This trial will be key in validating whether this next-generation intravascular lithotripsy device can deliver better outcomes, greater procedural predictability, and reduced vessel trauma. The Artero system uses circumferential sonic pressure waves at 4 Hz, roughly double the speed of current devices but is also designed with a low crossing profile and rupture-resistant balloon. Looking forward to catching up with Scott Nelson in the coming weeks and maybe even getting him on the other side of the microphone for a podcast episode 👀