Here's What the "Bigger Is Safer" Argument Gets Wrong

Before joining Rad AI, we spent years inside a $35 billion industrial conglomerate's medical division. We were in the meetings where product line decisions got made. What we learned there is why we're here now — and why the "safe bet" assumption deserves a serious second look.

When a prospective customer tells us they're nervous about working with a smaller company, we don't take offense. The instinct is reasonable. Healthcare procurement teams are accountable for mission-critical systems, and the idea that a big, established name is a safer bet has a logic to it.

Between the two of us, we spent years in the Medical Solutions division of 3M — an $8 billion healthcare division inside a $35 billion industrial conglomerate — and we sat at enough tables where product line decisions were made to tell you with some authority: the "big company = safe bet" assumption has a significant blind spot. It conflates the size of a company with the priority a specific product holds within that company. Those are very different things.

How product line decisions actually get made

Here's something that rarely makes it into vendor evaluations: large diversified companies make portfolio decisions constantly. When a business unit doesn't hit growth targets, or when the parent company's strategic priorities shift, or when capital needs to be redeployed somewhere with better returns — the conversation turns to which products stay, which get investment and which get managed out. These are rational decisions. We participated in versions of them. They have nothing to do with whether the product works or whether the customers like it. They are driven by P&L allocation, strategic fit and return on invested capital.

Customers are rarely in those conversations. By the time the impact reaches them — slower release cycles, support team restructuring and end-of-life notices — the decision has usually been made many layers above anyone who interacts with customers day-to-day.

We now see a fundamentally different operating model working at a start-up. Not better because we're small — better because the incentives are completely aligned with the customer in a way that a division inside a conglomerate structurally cannot be.

The 3M–Solventum–Thermo Fisher sequence is a perfect case study

We don't say any of this to criticize 3M, which is a company we both respect, learned enormously from and are still shareholders. We say it because the recent history of 3M's healthcare division is as clean an illustration of this dynamic as you'll find anywhere.

In April 2024, 3M spun off its entire healthcare division, the same $8 billion business we came from, as an independent public company called Solventum. The rationale was straightforward: healthcare had become non-core to 3M's industrial identity, and both businesses would be better served as separate entities. That's reasonable portfolio management, but it meant that customers of 3M Healthcare products suddenly had a new parent company they hadn't chosen.

Then, less than 18 months later, Solventum sold its Purification & Filtration business to Thermo Fisher Scientific for $4 billion — completed in September 2025. A billion-dollar business that had lived inside 3M for decades was now, in rapid succession, part of a healthcare spinoff, and then sold again to a life sciences company. Customers in that space experienced two ownership changes, two sets of new contacts, two rounds of "transition services" and two strategy resets — in under two years.

Again: these are rational corporate decisions, made by capable people trying to create shareholder value. They are also a useful illustration of what "big company stability" actually looks like when you're on the customer side of a product that isn't the parent company's core priority.

What focused companies get right

The argument for working with a focused, mission-driven company isn't that small companies never fail. They do. The argument is about incentive alignment and it's one we can speak to from both sides of the table.

At Rad AI, radiology isn't a division. It's the company. Every engineer, every product decision and every support model exists to solve one problem: making radiologists faster, more accurate and less burned out. There is no competing priority. There is no portfolio review where our product loses to something with better margins in a different vertical. There is no acquirer waiting in the wings who bought us for a different capability and will eventually rationalize us out of their roadmap.

Tom Hasley, CIO of Lucid Health, a physician-led network serving more than 140 facilities, transitioned more than 300 radiologists to Rad AI reporting and described the support experience this way in a recent webinar: Rad AI identified a radiologist whose speech recognition accuracy had quietly degraded and reached out before the radiologist had even noticed. 

"I was actually surprised," he said, "that somebody was proactively reaching out before we had to call in and issue a support ticket. That radiologist hadn't even said anything — it was just picked up in the background." That's what happens when the vendor's entire business depends on your radiologists succeeding.

The right question to ask every vendor

The question isn't how big a vendor is. The questions that actually predict long-term partnership are: 

• Is this product core to their existence, or is it one item in a portfolio? 
• What happens to this product line if their strategic priorities shift? 
• Who owns the roadmap — and have they spent real time working in your domain? 
• And when you call with a problem, are you a named account or a ticket number?

We know how those conversations go inside large organizations because we've been in them. We came to Rad AI precisely because we wanted to be on the side of the table where the answers are different. 

Radiology is not a line item here. It's everything.