Justin Fulcher has a specific definition of uncertainty, and it's not the one that shows up in leadership books. "Uncertainty isn't not knowing what's going to happen," he says. "It's having to act before you do." The distinction matters to him because it shifts the question from how to predict better to how to decide better. And that's a more useful frame for anyone who has spent time building things in environments that don't stay still.
His own experience with those environments spans two decades: a telehealth platform built from a solo prototype into a fifty-country operation, a product pivot from consumer marketplace to federal compliance infrastructure, and a term of public service inside some of America's most complex institutions. What follows are the principles he's developed along the way.
1: Trade the Plan for Flexibility
RingMD began with no company name, no investor materials, and no formal plan. Fulcher had been traveling through Southeast Asia, had seen a problem he thought was worth solving, and started coding. "For a number of months, it was essentially a hobby project," he has said. Investors approached him before he had a pitch.
That sequence wasn't accidental – but it also wasn't a strategy he'd consciously designed. It reflected something he's since come to believe about preparation. "Planning gives you a document. Preparation gives you a reflex. The document becomes useless the moment conditions shift. The reflex doesn't."
The distinction shows up in how this technology founder approached every new market RingMD entered. The platform incorporated artificial intelligence modules for clinical decision support and screening – capabilities that had to perform reliably across wildly different regulatory and connectivity conditions. The regulatory environment in India was different from Indonesia, which was different again from the US federal system. No plan survived contact with all three. What traveled between them was a set of instincts about how to read institutional drag, earn trust, and move forward without waiting for certainty.
2: Make the Call Before the Information Is Complete
When RingMD was pushing into markets where telehealth services had no established foothold, Fulcher was making significant product and partnership decisions on incomplete information. "You never have what you wish you had. At some point, you have to decide on the basis of what you know and build in the correction later."
The clinical resistance RingMD faced entering new markets made this especially acute. Whether a government would partner, whether a hospital system would adopt, whether doctors would engage – these were judgment calls, not certainties. Waiting for guarantees wasn't an option in markets where the competitive window was narrow and conditions changed fast.
What he learned, across multiple such environments, is that the refusal to decide is itself a decision – and usually a more expensive one.
"Inaction has a cost that doesn't show up on the ledger until later. By then, it's harder to reverse." It's a view he's expanded on elsewhere: the most expensive mistakes rarely announce themselves at the time they're made.
3: Separate What You Control from What You Don't
Scaling RingMD across fifty countries meant operating inside conditions Fulcher could not change: regulatory frameworks built around assumptions that predated telehealth, connectivity limitations in rural markets, procurement processes that moved at institutional pace. The temptation in those environments is to treat every obstacle as a problem to be solved. Fulcher doesn't see it that way.
"There are problems and there are conditions. A problem has a solution you can work toward. A condition is the environment you're working inside. Conflating the two is how teams burn energy on things they can't move."
His discipline, developed over years of operating across regulated environments with competing incentives, is to quickly identify which category something falls into and allocate effort accordingly. With conditions, the job is to build something that operates within them. With problems, the job is to fix them. Running those two modes simultaneously, without confusing one for the other, is one of the harder skills in leadership. It's also one of the most necessary in genuinely uncertain environments.
4: Keep the Team on the Mission, Not the Moment
When RingMD pivoted from its Singapore-era consumer marketplace to a government-focused compliance platform in the US, the shift was significant. The product looked different, the client base looked different, and the day-to-day work looked different. What Fulcher held constant was the underlying purpose. "The mission was always the same. Connect people to healthcare they couldn't otherwise reach. Everything else was execution."
That constancy, he argues, is what allows teams to absorb operational change without losing coherence. When circumstances shift (and in uncertain environments, they always do), a team anchored to a fixed plan comes apart. A team anchored to a fixed mission adapts. "Plans change. Timelines shift. External conditions change," he has written. "That is not evidence of weakness. It is the cost of operating in reality rather than in slides."
The leaders he has seen struggle in uncertain environments are often the ones who treated their plan as the mission. When the plan had to change, so did their footing.
5: Build the Instinct, Not Just the Answer
The through-line across all of it, in Fulcher's view, isn't any specific tactic or framework. It's a set of instincts that develop only through repeated exposure to environments that don't give you enough information, enough time, or enough control.
"You don't get good at uncertainty by studying it. You get good at it by operating inside it long enough that the discomfort stops costing you time."
For Justin Fulcher, that process started at nineteen with a prototype he built before he had a company. It continued through every market RingMD entered, every institutional partner it had to convince, every compliance framework it had to navigate. By the time he stepped into a government role as a senior advisor to Secretary of War Pete Hegseth and senior staffer at the Defense Department, the instinct was already there. The specific domain was new. The underlying problem – core systems running below their potential, constrained by outdated processes that had never been revisited – was one he'd been working inside for years.
What the Work Actually Taught Justin Fulcher
Fulcher didn't develop these principles by studying the theory of uncertainty. He developed them by fearlessly committing to the work; to developing RingMD in markets where the infrastructure was unreliable, the institutions were resistant, and the information was always incomplete. The principles are a byproduct of that. They're not a framework he designed, but a set of habits that formed because the environment required them.
That's probably the most useful thing to take from his experience. The leaders who handle uncertainty well aren't the ones who studied it. They're the ones who stayed in the trenches long enough to stop being afraid of it. For Fulcher, that work now extends into his future endeavors in defense technology and national security. And by his own account, it's just the beginning.
