The 1% Rule: How I Learned to Turn Scarcity into Opportunity

Most people see scarcity as a challenge. I learned to see it as an opportunity.

At the start of my career, I was driven by a desire to make a real difference in people’s lives. Helping patients regain function and return to the activities they loved was incredibly fulfilling. But with that passion came pressure—The weight of my own expectations and the fear of falling short. Instead of letting it hold me back, I used that fear as fuel, pushing myself to achieve more.

Fresh out of surgical training at some of the most esteemed institutions, I was eager to establish myself as a leader in my field. But with so many possibilities within orthopaedic sports medicine, it was overwhelming.

Where could I focus my efforts to have the greatest impact?

Navigating Overload vs. the Unknown

After hours of contemplation, I decided to take a more systematic approach. Using the world’s largest medical research database, PubMed, I analyzed publication volumes across various subspecialties to identify knowledge gaps—areas where research was scarce, but the potential for impact was significant.

In the spring of 2009, I began my search. I started with ACL (knee) surgery. To my surprise, there were already around 10,000 publications on the topic. The sheer volume was staggering. To make a significant contribution in such a well-established field would require relentless effort, possibly over a decade, just to make a dent.

Looking for an alternative, I shifted my focus to the shoulder and searched for rotator cuff surgery. This time, I found over 4,000 publications - not as daunting, but still a field with existing literature. Although I never shied away from hard work, I knew time was finite, and I needed to invest my efforts where I could create the greatest impact.

Finally, I turned my attention to something relatively new: hip impingement. To my surprise, there were only about 500 publications on the topic at the time—a stark contrast to the thousands I had found in knee and shoulder surgery.

This raised an important question: Why was there such a scarcity of research? Was it an insignificant issue? Or was it simply too new to have gained traction?

The 1% Rule: Turning Scarcity into Strategy

After weeks of reflection, I had an epiphany. If I published just five papers in a year, I would contribute 1% of the world’s total knowledge on hip impingement at that time.

That realization was game-changing. Instead of competing in a red ocean of established research, I saw an opportunity to lead in a blue ocean of discovery. The scarcity of knowledge wasn’t a roadblock—it was an open door. So, with the goal of 5 publications in my first year of practice, I went to work.

One year later, I counted my publications in PubMed. I had reached my goal. I was indeed responsible for 1% of the world’s knowledge for that year.

From Scarcity to Success

What started as an experiment turned into a career-defining decision. It reinforced a powerful concept: Focusing on an area with limited and yet growing expertise can accelerate career growth. By embracing scarcity, I was able to:

• Build a highly successful research program

  • What began as a simple five-paper goal evolved into a long-term research initiative. As time passed, I uncovered new questions, collaborated with medical giants, and played a leading role in shaping the field of hip preservation.
    

• Contribute to meaningul advancement in patient care

  • Every study and publication wasn’t just about academic achievement—it was about real-world impact. With limited existing knowledge, even small discoveries had a big effect, leading to better surgical techniques, improved diagnostics, and more effective treatments for hip impingement.
    

• Establish myself as a thought leader

  • In a field with tens of thousands of experts, recognition can take decades. But in a space still evolving, there is an opportunity to shape the future. I didn’t just follow in others’ footsteps, I had the chance to help define the conversation.

Years later, my work in hip impingement has opened the door to global collaborations, funded research, leadership roles, and the privilege of mentoring the next generation of surgeons. Most importantly, it led to tangible changes in patient care, helping thousands of people around the globe receive better treatments and avoid invasive surgeries.

Today, I am a proud recipient of a Canada Research Chair in Joint Preservation Surgery—a role shaped by my decision to embrace the 1% rule.

Your 1% Opportunity

Looking back, I often wonder: What if I had chosen a different path? Fortunately, I didn’t let the scarcity of knowledge deter me—I let it guide me.

And now, I pose the same question to you.

Scarcity exists in every field, not just medicine. The biggest breakthroughs often come from the areas with the fewest answers—The spaces where curiosity, persistence, and innovation have the power to create real change.

According to Robert H Schuler, "The secret to success is to find a need and fill it; find a hurt and heal it; find a problem and solve it."

What needs exist in your community/industry today?

So, I challenge you:

💡 Could you make your mark by contributing just 1%?

💡 What gaps exist in your field?

💡 How do you identify key needs in your field? What’s your industry's version of PubMed?

Let’s discuss. Drop your thoughts in the comments/discussion board - and if you’re ready to turn scarcity into strategy, join our community at www.thenotchacademy.com.