You almost didn't notice it happening.
That's the part nobody talks about. Not the frustration, which everyone in this position feels, but the gap between when it started and when you could name it. There's no letter. No meeting. No moment where someone sits across from you and says: we've decided you're not the right person for the next stage. It just becomes structurally true, gradually, while you're still doing the job you were hired to do.
By the time you can name it, it's already been true for several months.
I recruit commercial leaders for medical device companies for a living. And what I've seen, enough times that I now consider it a feature of the sector rather than an anomaly, is this: the people who build the commercial engine at post-clearance or post-Series B stage are often not the same people the company needs to run it two years later. Not because they failed. Because the job changed around them without anyone formally redesigning it.
The structural reason this keeps happening
Medical device companies at the post-clearance stage need a Pioneer. Someone who operates in ambiguity, builds process from nothing, maps a reimbursement landscape nobody has mapped before, and generates early revenue evidence without the brand recognition to make it easy. That role is genuinely hard. The people who do it well are motivated by the blank page, energised by building rather than running, and comfortable with a governance structure that doesn't exist yet.
The same company at Series C, with a functioning commercial engine, an NHS framework agreement or established GPO relationship, and a board expecting institutional-grade reporting, needs someone different. Someone who can manage at scale, operate within a governance structure, and present commercially to sophisticated investors. That's not a harder or easier role. It's a different one.
What creates the problem isn't the company's decision to bring in a different profile. It's that nobody ever has the explicit conversation about it. The new hire appears above you. The scope adjusts around you. The decisions start happening without you. And you're left trying to interpret what's changed through the fog of a situation where nothing has officially changed at all.
The three signals
There are three observable patterns worth watching, not as feelings but as facts.
Decision bypass. Decisions that fall inside your obvious scope are being made without your input and communicated to you after. Not once. Repeatedly.
Specification creep. The role has been disaggregated around you: pieces assigned to other functions, new roles created that used to sit inside yours, no conversation about what you're now actually responsible for.
Future tense exclusion. The conversations about where the company is going are happening without you in the room. You hear about them afterwards.
One is noise. Two or more, sustained over more than a quarter: the company has already made a decision it hasn't formally told you about.
The conversation worth having
Have it early. Before the frustration compounds. Before the conditions deteriorate.
It isn't a confrontation. It's one clarifying question asked directly: what does success in this role look like over the next twelve months, and is that role the one I'm currently doing?
The answer tells you everything. Specific and forward-looking: there's material to work with. Vague and reassuring: that is also an answer.
Some of these conversations produce a redesigned role. The company genuinely hasn't been explicit about what it needs from you at this stage, and naming it creates the space for something better. Some don't. Not because of bad faith. Because what the company needs and what you're built to do are genuinely different things. That's not a verdict on your ability. It's information about fit.
How to leave well, because medtech is smaller than it looks
The clinical networks, investor circles, KOL communities, and GPO relationships in this sector overlap in ways that will bring you back into contact with the people you're leaving. Probably sooner than you expect.
Document your commercial record before you leave. The pipeline you built, the accounts you converted, the reimbursement milestones, the team you developed. These are yours. Don't reconstruct them from memory in an interview room six months from now.
And leave the resentment behind. Not the feeling: the expression of it. The narrative that the company grew around you while you were sidelined is accurate. It's also unattractive in a room full of people deciding whether to trust you with their next commercial build. The more useful narrative: you recognised that the environment had changed, and you made the decision to take what you built into a company that actually needs your specific profile right now.
The most credible candidates in the medical device commercial market aren't the ones this has never happened to.
They're the ones who saw it clearly and moved deliberately.