Archaic design leadership; highly bureaucratic India branch. Pros: The core US MedTech product is fundamentally strong, and the compensation bands look competitive on paper. Cons: There is a massive disconnect between the innovative US product goals and the actual leadership culture in the India office. The design leadership operates on an outdated, rigid, agency-style hierarchy. During the interview process, it became immediately clear that they are not looking for autonomous, AI-native 0-to-1 thinkers. The management style feels highly restrictive, heavily focused on compliance and "knowing your place" rather than driving design velocity. If you are an energetic, autonomous Senior/Principal designer who expects to operate as a peer, this culture will instantly drain and stifle you. They are optimising for subservient cogs, not tech architects. Advice to Management: US leadership needs to seriously audit the hiring culture and middle-management filters in the India GCC. You are bleeding top-tier, autonomous talent because your local gatekeepers are filtering out high-velocity innovators in favour of candidates who will simply nod and follow rigid, archaic orders.