How Market Engineering Changes What Medical Device Sales Requires
Medical device sales dominates most medtech companies because it's the function closest to revenue. That dominance makes sense structurally, but it also means market engineering, the category, messaging, and narrative work that should happen first, gets skipped in favor of hiring more reps.
I covered why this pattern persists on a recent episode about raising capital without traction: How Market Engineering Helps MedTech Startups Raise Capital.
Key Takeaways
- Medical device sales usually runs the company, not just the pipeline. Sales gets the compensation, the influence, and the promotion path.
- Hiring more sales people doesn't fix a misdefined market. It just burns through cycles faster with the same weak results.
- Stryker built its sales culture deliberately, with public recognition and bonuses reinforcing the same competitive behaviors year after year.
- Training is usually the last function medtech companies staff, added only after a sales team is already large enough to need it.
- Market engineering doesn't replace medical device sales. It gives sales a defined market to sell into instead of one it has to explain from scratch.
Why Medical Device Sales Runs Most Medtech Companies
Look at who advances inside a medical device company, and the pattern is consistent. Sales gets promoted. Sales gets the biggest bonus checks. Sales gets the influence.
I discussed this dynamic with Armen Vidian on an episode about medtech venture capital. He put it directly:
"The division of the company running the show is usually sales. They're often the most well compensated by far. And because they have the most customer interaction, they have the most sway."
— Armen Vidian (The State of MedTech)
That structure isn't accidental. Compare it to software, where engineering backgrounds dominate leadership. In medtech, customer-facing revenue generation sets the culture, and everything else, including marketing and category work, organizes around it.
The result is a company that's very good at selling and much weaker at defining what it's selling into in the first place.
Armen made a related point about where marketing talent goes in medtech. Most marketing hires come from product management or commercial operations backgrounds, not from category or brand disciplines the way they would in tech or SaaS. So marketing ends up supporting sales rather than shaping the market sales sells into.
It's a structural consequence of building the org around medical device sales from day one, without ever staffing the category work that should sit upstream of it.
Why Hiring More Medical Device Sales Reps Rarely Fixes a Stalled Market
When growth stalls, the instinct is to add headcount. Hire two more reps, cover more territory, push harder.
I explained why that instinct backfires on the same episode:
"Hiring more sales people isn't going to fix this. You can't outsell a misdefined market."
Every new rep still has to explain the category from scratch on every call. The team gets bigger, the payroll gets heavier, and the underlying problem, a market that was never clearly defined, doesn't move.
This shows up fastest in companies that are otherwise well capitalized. They've raised real money, built a real product, and hired a real medical device sales team. And the numbers still don't move, because the team was set up to sell into a market that was never engineered.
I see this pattern most clearly in companies two or three years into commercial operations. The founding team assumed medical device sales would compound the way it does once a category is established.
Instead, growth plateaus, and the board asks for more reps because that's the lever everyone already understands how to pull.
Adding reps at that point doesn't reset the clock. It just runs the same undefined pitch through more people, faster, with the same conversion problems multiplied across a bigger payroll.
How Stryker Built a Medical Device Sales Culture That Still Runs the Company Today
Sales-first culture in medtech isn't new. Stryker's John Brown built it deliberately, decades ago, and the company still runs on it.
I broke down the mechanics of that culture on an episode about Stryker's leadership history:
"Top sales performers were invited to have breakfast with John Brown. Everyone else had their own separate breakfast. Each top performer went up on stage, gave a story about how they achieved their goals, and John personally handed them their bonus check."
That ritual, repeated annually, made competitive sales performance the company's central value. It worked for Stryker, which grew into one of the largest companies in medtech during Brown's tenure.
But that same model gets copied by companies without Stryker's category position. A young medtech company without a defined market can build the same sales-first culture and get very different results, because the culture rewards selling harder into a market that was never engineered in the first place.
Stryker could afford that model because the category was already established by the time the ritual took hold. Competitive recognition sharpened execution against a market that already understood what Stryker sold and why it mattered.
A pre-traction medtech company copying the same recognition system rewards the wrong behavior. It pushes reps to sell harder into a market that hasn't been defined yet, instead of rewarding the category work that would make selling easier for everyone on the team.
Why Training Is the Last Function Medical Device Sales Teams Get
Look at how medtech companies build their commercial org, and training is almost always the last hire.
I discussed this pattern with Gene Nagel on an episode about medical sales training:
"When they go to hire their commercial org, training is not included in that. It's VP of sales, it's VP of marketing. Training is an afterthought."
— Gene Nagel (The State of MedTech)
Companies wait until they have 20 or 30 reps before hiring someone to train them properly. By then, the reps have already been selling without a shared, defined message for months.
That sequencing mirrors the bigger pattern across medtech. Sales gets built first because it's tangible and measurable. Everything that should support sales, training included, gets added later, after the gaps are already showing up in results.
The cost of that sequencing compounds over time. Untrained reps default to whatever pitch feels natural, and without a shared script rooted in a defined category, ten reps can end up describing the same product ten different ways.
That inconsistency looks like a training problem on the surface. It's usually a category problem wearing a training problem's clothes, since there was never one clear message to train the team on in the first place.
How Market Engineering Changes What Medical Device Sales Requires
None of this is an argument against medical device sales as a function. The companies that scale fastest still need strong sales teams.
What changes is what sales requires before it can perform. A defined category, tested messaging, and a credible narrative give a medical device sales team something real to execute against, instead of a market it has to define on every call.
I've watched this play out the same way across 400-plus episodes of State of MedTech. The companies with the strongest sales results usually did the category work first, then let sales execute against something already proven to resonate.
This connects to what I've written about what US Surgical knew about medical device sales reps and the three stages founders skip when building a medical device sales organisation.
What This Means for Medtech Founders
In my experience working with medtech founders, the pressure to hire more medical device sales reps shows up before the category work is finished, almost every time. Sales feels like progress. Category design feels slow by comparison.
But a bigger sales team executing against an undefined market just scales the same problem faster. More reps, more payroll, more pressure, and the same conversion rate.
I tell founders to check one thing before their next sales hire: can the existing team explain, in one sentence, why this category exists and why it matters right now? If the answer isn't sharp, the next hire should go into category work, not another sales territory.
This isn't a call to shrink medical device sales teams or slow down hiring altogether.
It's a call to sequence the hiring correctly, so the reps a company does bring on are executing against a market that's already been defined rather than one they have to build from scratch on every call.
Founders who make that sequencing change usually see it show up first in ramp time. New reps close their first deals faster, because the pitch they're learning is already proven rather than improvised territory by territory.
Frequently Asked Questions
Why does sales dominate the culture at most medical device companies?
Sales sits closest to revenue, has the most customer interaction, and historically gets the clearest promotion path and compensation. That combination makes sales the most influential function inside most medtech organizations, even when other functions like marketing and training are equally important to growth.
Does hiring more medical device sales reps increase revenue?
Only if the market the reps are selling into is already defined. Adding reps to a misdefined market increases cost and activity without proportionally increasing conversion, since each new rep still has to explain the category from scratch on every call.
When should a medtech company hire someone to train its medical device sales team?
Ideally before the team scales past a handful of reps. Most companies wait until they have 20 or more reps before adding training, by which point the team has already been selling without a consistent, well-defined message for months.
Listen to the Full Conversations
I covered the market engineering framework on How Market Engineering Helps MedTech Startups Raise Capital. Armen Vidian joined me on Rethinking Medtech VC and AI Enabled Devices.
I covered Stryker's leadership history on John Brown's Leadership Playbook: How Stryker Grew from $17M to $4.3B. And Gene Nagel joined me on The Problem with Medical Sales Training and How to Fix It. Subscribe wherever you listen to podcasts.
About the Author
Omar Khateeb is the founder of MarketCraft and host of The State of MedTech, the number one podcast in the medtech industry.
He works with medtech founders and commercial leaders on market engineering, commercialization strategy, and revenue growth. Visit marketcraft.ai or subscribe to The State of MedTech for weekly conversations with the people building the future of medical devices.