If you don't want to get in bed with Big Pharma or Big Device, think small.
Several of my co-authors on this site have described their experiences working for large biopharmaceutical or device companies. While I work with a few as a consultant, most of my experience has been in starting and developing my own companies or consulting to early stage companies. Here are some experiences and lessons learned working with small companies:
You are being hired to provide the 3 C's
Early stage companies hire you because you provide the 3 C's: credibility, content and domain expertise and connections. They want your credentials on their website to raise money and establish credibility with investors. They want you to connect them to other thought leaders, users or participants in future clinical trials. They are looking for bioangels and early stage investors and turn to you for connections. They don't want you just because you have MD after your name.
Startups expect you to work for equity
Early stage companies have little or no money. Their first priority is to save cash and survive to the next step of development and commericalization. If you don't have that kind of risk tolerance or are looking for a big salary supplement, you are barking up the wrong tree.
You will be a co-chief cook and bottle washer
This is the fun part. In the beginning. there will be an organizational chart that includes the CEO, Sales and Marketing, Finance and other functions. In the beginning, maybe two or three people fill the boxes. You will be expected to supplement them and play multiple positions on the team until it gets to the point where the company can afford to hire specialists, like a CFO to help with a private placement memorandum, or a Director of Sales and Marketing to handle the sales force.
You will fail more often than you succeed
Let's face it. Creating a successful biomedical company is a crap shoot. Don't put all of your eggs in one basket and try to work with a portfolio of companies to increase you liklihood of success. The more experience you get, the better you will get at spotting the losers up front.
If you want to work with industry, you don't have to be the Man in the Grey Flannel Suit. I think it's more fun to wear jeans and a black tee shirt.