Recently, I joined a leadership community called Rands Leadership Slack. Every few weeks, they host a Fractional CTO Coffee Chat (Shout out to David Stenglein and Hunter Harris) — a virtual meetup where fractional CTOs share experiences, swap advice, and discuss the realities of this increasingly common role.
One of the most frequent questions that comes up in these chats is: What exactly is a Fractional CTO? It’s a fair question, because everyone seems to have a slightly different answer.
Here’s mine: a Fractional CTO sits somewhere between a consultant and an individual contributor.
An individual contributor focuses on execution — you give them a task, and they build what you need. A consultant, on the other hand, helps shape strategy: What’s the plan? How do we get from where we are to where we want to be?
A fractional CTO blends both. They’re a hands-on consultant — involved enough to understand the technical details, yet high-level enough to define direction and strategy.
Why Fractional CTOs Matter for Early-Stage Companies
Fractional CTOs are particularly valuable for early-stage startups that haven’t yet separated strategic leadership from day-to-day execution. These organizations often need a "general in the trenches" — someone who can shape the technical roadmap while still writing code when necessary.
They’re also a more capital-efficient way to get senior technical leadership. Hiring a full-time, highly experienced CTO is expensive and can burn a lot of runway, especially if that person spends a meaningful chunk of their time on work that doesn’t require an executive. A fractional CTO lets you buy just the amount of leadership you actually need, and then use the savings to hire full-time engineers who focus on execution and product delivery. If you have capital to spare, a full-time CTO can make sense — but most startups don’t, and they’re better off stretching their runway with a fractional model.
Over the past three years, I’ve worked as a fractional CTO for companies across industries: hospitality, culinary, online gambling (never again), crypto (definitely never again), and healthcare. Among these, my work with healthcare startups has been the most rewarding.
The Healthcare Advantage
For the past year and a half, I’ve partnered with Genetics Adviser, a healthcare company. In that time, I’ve rebuilt their infrastructure from the ground up, established their DevOps practices, hired two internal engineers, supported their SOC 2 and HIPAA compliance efforts, navigated multiple security audits, and performed technical cost analyses — all while helping a non-technical leadership team understand how technical decisions influence the business model.
Early-stage healthcare companies are uniquely well-suited to the Fractional CTO model. Unlike other startups, they can’t ignore compliance or treat security as an afterthought. To partner with healthcare systems, they must have a secure and compliant product — the stakes are simply higher when handling sensitive health data.
Complexity and Specialization
In most industries, an early-stage startup can spin up a quick SaaS product and iterate. Healthcare is different. Every system is complex and idiosyncratic, requiring deeper customization and integration. These challenges demand strategic technical leadership, but not necessarily on a full-time basis.
Many healthcare startups don’t need a dedicated infrastructure or DevOps team — not yet. Hiring full-time specialists for these areas can be expensive and unnecessary at an early stage. Instead, a fractional CTO can design the systems, implement core foundations, and bring in specialized talent only where it’s needed, ensuring resources are used efficiently.
My Focus Going Forward
This year, I’m refocusing my Fractional CTO practice on helping early-stage healthcare companies. It’s where I’ve found my work makes the largest impact — blending strategy, technical leadership, compliance, and security into a single, part-time role that helps these companies grow responsibly and effectively.