Startup Equity: The “FAST” Agreement: medical career toolkit (2026)

Doctors get exploited in startups because “mission” replaces compensation. Your rule: no meaningful deliverable without a contract. Equity is not a compliment; it is a priced instrument with risk, dilution, and time.

Do not work for free

If the startup cannot pay anything, you are not an advisor—you are unpaid labour subsidising their burn rate. Minimum viable deal: cash retainer + defined scope + equity on vesting.

FAST (Founder/Advisor Standard Template) — why it exists

FAST is a standardised advisor agreement and equity framework. It explicitly includes a 3-month cliff and ties equity to (a) company stage (idea/startup/growth) and (b) advisor engagement level. The framework examples include outcomes such as ~1% for an “expert” level advisor supporting an early-stage startup with meaningful monthly input.

Advisory shares vs co-founder equity (don’t confuse the instruments)

Advisory equity is typically small (often ~0.1%–1%) and tied to defined contributions. Co-founder equity is fundamentally different (often 10%+), because you are signing up for existential risk, execution ownership, and long-term vesting. If you are building product, selling, hiring, and carrying delivery risk, you are not an “advisor.”

Vesting (correctly defined)

Vesting means you earn equity over time only if you keep delivering. A common founder/employee structure is 4-year vesting with a 1-year cliff (nothing earned before 12 months; then monthly/quarterly vesting). FAST, specifically, uses an advisor-friendly structure with a shorter cliff (3 months) and a shorter vesting horizon (commonly 2 years).

The negotiation script (MECE)

Step 1 — Define your role: Advisor vs Operator

MECE test: If you only provide guidance/intros/credibility → advisor. If you are responsible for outcomes (ship, revenue, delivery) → operator/founder. Choose the correct compensation model.

Step 2 — Price the scope, then choose the instrument

Scope examples: “clinical safety sign-off”, “medical device pathway”, “clinical evidence plan”, “enterprise NHS stakeholder mapping”. Instrument options: cash, equity, or blended.

Step 3 — Protect against dilution and endless scope

You need: vesting, cliff, termination terms, confidentiality/IP, and a definition of “material change of scope” that triggers renegotiation.

Step 4 — Make the upside real

Ask for information rights (quarterly updates), clarity on option vs shares, and whether the company has an option pool. Equity without cap table context is theatre.

Source

Open Link

Source

Open Link

Your learning path

Save your place and choose what comes next

Work through this guide (4 steps)

Use the actions from this article to track what you have worked through.

Step 1 — Define your role: Advisor vs Operator
MECE test: If you only provide guidance/intros/credibility → advisor. If you are responsible for outcomes (ship, revenue, delivery) → operator/founder. Choose the correct compensation model.
Return to this section
Step 2 — Price the scope, then choose the instrument
Scope examples: “clinical safety sign-off”, “medical device pathway”, “clinical evidence plan”, “enterprise NHS stakeholder mapping”. Instrument options: cash, equity, or blended.
Return to this section
Step 3 — Protect against dilution and endless scope
You need: vesting, cliff, termination terms, confidentiality/IP, and a definition of “material change of scope” that triggers renegotiation.
Return to this section
Step 4 — Make the upside real
Ask for information rights (quarterly updates), clarity on option vs shares, and whether the company has an option pool. Equity without cap table context is theatre.
Return to this section

Finances · Article 5 of 16