Medium-size businesses account for over one-third of private-sector output and employ over one-third of employees across industries. However, current literature describing entrepreneurship and growth does not address the unique needs of medium-size businesses. This article aims to conceptually synthesize the literature on entrepreneurship, founder’s vision and sustainable growth pertaining to medium-size businesses. It proposes a conceptual framework for understanding sustainable growth and its complexities as it relates to different sizes of businesses. It sheds insights on the relationship and intersection of these three areas of study, offering propositions, questions as well as issues worth pursuing in empirical investigations in the future.