Roger Assaker (MDsim)
Roger Assaker on carrying experience into a new industry, learning what he did not know, and building the right people around the questions he needed to answer.
Roger Assaker was not a first-time founder when he started MDsim.
He had already built and sold a successful technology company developing simulation software for aerospace and automotive companies. He founded it in 2003, sold it in 2012, stayed through two acquisitions, and eventually became CEO of the company that had acquired him.
It was the kind of outcome many founders work towards.
But it was no longer the kind of work Roger wanted to do.
“During COVID, my job was a call every half hour across the globe,” he says. “It became more about controlling costs and financial reporting rather than building teams, building products and going to see customers.”
He was seeing fewer customers, spending less time with the team and doing less product innovation.
“I said, you know what? I’m more of a startup guy.”
So he started again.
This time, in medtech.
MDsim is developing medical software that creates digital models of a patient’s spine from X-rays, MRIs and CT scans. The aim is to help doctors prevent back problems and plan complex spine surgery before entering the operating room.
Roger understood simulation. One brother understood neurosurgery. A third brother brought experience in quality and operations.
But building a medtech company required knowledge that went far beyond the founding team: regulation, clinical workflows, spine biomechanics, product development, hospital decision-making and the realities of selling into healthcare.
Roger had experience building a company.
He did not have all the answers for building this one.
What he did have was a way of going after them.
Roger and his brothers
Roger was direct about his knowledge gaps from the beginning.
“I told them: I don’t know anything about spine. Teach me. What is your dream? What do you need?”
Instead of trying to become the expert in every part of the business, he built access to people who could answer different questions.
He created a medical advisory group of surgeons from several countries to help MDsim understand clinical needs and challenge the product.
Then he created a second group of professors and researchers who had spent their careers studying spine biomechanics.
“They know everything about the mechanics of the spine that I don’t know.”
Roger also looked for people who had already made the journey.
“I called a couple of scale-ups in medical because I acknowledged that I didn’t know anything.”
What interested him was not only what they had done well, but what they had got wrong.
One founder told him that their company had spent two years developing a product before realising it needed a formal quality system.
“They had to stop everything and do the quality system.”
Roger’s response was immediate:
“I decided directly to start with the quality system.”
MDsim did not have to spend two years making the same mistake.
Someone else had already paid for that lesson.
This was not about collecting advisers. Different questions required different people.
The value was in exposing gaps before they became expensive.
There is another side to entering an industry where other people know more than you.
It can become easy to assume they know better.
Not every attempt to fill a knowledge gap worked.
“The most expensive mistakes were hiring different kinds of consultants that did not pay back enough.”
The problem was timing.
“We were very early. We didn’t know what we needed to build.”
Roger had recognised a knowledge gap, but that did not automatically mean the people hired to fill it had the right answer.
“When you get into a new industry where you don’t know a lot, you think that others know better than you. Very fast, you discover that they don’t know much more than you.”
Looking back, Roger would slow that part down.
“I would take more time to understand everything before hiring consultants.”
But the experience did not make Roger less interested in outside perspectives.
He still actively looks for people who will challenge him.
He once went to an investor with a clear instruction:
“Kill me if you can. Tell me what you would do differently. Don’t be kind.”
He wants the criticism.
But he does not outsource the judgment.
“I listen to every piece of advice, but I filter it through my own thinking.”
Then he decides.
“At the end of the day, I do whatever I want.”
That distinction is important.
The goal is not to surround yourself with people who make decisions for you.
It is to surround yourself with people who make it harder for you to make a bad one.
Roger came into MDsim with habits that had worked well in his first company.
One of them was speed.
In his previous business, a conversation with a vice president from a large aerospace OEM led Roger to sketch a product idea on a napkin, send it to his team that night and present it the next morning.
The idea later became a product.
That was the kind of speed Roger was used to.
One of his mottos had been:
“Fake it until you make it, but always make it.”
Medtech was different.
“In the medical area, you cannot fake it. You need to get everything developed. You need to get everything certified before you can sell something.”
Medical products require design, testing, verification, validation and regulatory approval. The opportunity to release something unfinished and improve it through rapid customer feedback is far more limited.
Roger had to accept the constraint without giving up the instinct behind his old approach.
“You have to be patient. But I don’t change my attitude. I’m still trying to keep agility.”
So he looked for what could still move.
“We don’t wait to finish a product to market the product.”
While development and certification followed their own timelines, MDsim could still educate the market, build relationships, create credibility and develop thought leadership.
The goal was to shorten the distance between approval and adoption.
“So when the product is out, we should be known enough to be adopted.”
Roger could not simply copy the playbook from his previous company.
But he did not need to discard the instinct behind it either.
The challenge was understanding where that instinct still worked and where the industry demanded something different.
Roger has kept another instinct from startup life: adjust when new information appears.
“I’m pivoting all the time. Every day.”
MDsim started with a product focused on complex spinal deformity surgery. The company later explored prevention and more common degenerative spinal conditions.
Roger does not describe those changes as complete pivots.
“I never had to pivot 180 degrees.”
For him, adjusting is part of learning.
But in medtech, every adjustment has a cost.
Some costs are obvious.
A product change can mean more development, more testing, more certification and more time.
Others are harder to see.
“It bothers some team members because I keep adjusting all the time. They can think you don’t know where you are going or that you change your mind.”
Roger may see new evidence and a reason to adjust.
The team may see another change of direction.
The less visible cost is confidence in the direction.
Every adjustment asks the people building the company to absorb another change and continue believing in where it is going.
The challenge is not simply knowing when to change direction.
It is recognising that every change asks something from the company, and not all of those costs appear on a development plan.
Roger’s experience did not mean he entered medtech with the answers.
It showed in what he did when he didn’t have them.
He built access to people who could expose the blind spots he could not see alone.
He listened widely.
Then he filtered what he heard through his own judgment and made the decision himself.
His previous experience gave him instincts he could carry into MDsim.
Medtech forced him to rethink how to use them.
For an early-stage founder, that may be one of the more useful forms of experience to borrow from Roger.
Not his answers.
His approach to finding them.
You do not need to have all the answers. But you need to build a way of finding better ones.