Work Hard and Be Bold
You can get to the 90th percentile of your field on smarts or effort alone. The 99th takes both. Altman is blunt about it: extreme people get extreme results, and hard work compounds like interest, so the earliest years count most.
He's equally blunt that this has a cost, and that the answer isn't grim endurance. Find work you enjoy with people you like being around, learn momentum (working hard gets easier when you're winning), and figure out how to sustain the pace without breaking.
Boldness is the direction to point all that effort. It's easier to do a hard startup than an easy startup, because meaningful problems attract talent and money in a way that incremental ones don't. Follow your curiosity toward something important. If you're making steady progress on a problem that matters, people will line up to help.
“It's easier to do a hard startup than an easy startup.”
Key idea
The 99th percentile takes smarts and extreme effort. Point that effort at a hard, important problem: ambitious missions recruit better than easy ones.