What Is Traction? Axonics' 20-Quarter, $3.7B Answer

What is traction in business? Startup traction is repeatable, measurable demand. In medtech, it shows up as consistent conversion, shorter sales cycles, and buyers describing the problem in your language before your sales team explains it.

Revenue, FDA clearance, and physician enthusiasm are inputs toward traction. Most founders never reach the real thing because they measure those inputs and stop there.

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Key Takeaways

• Startup traction in business means repeatable, measurable demand, not revenue milestones or physician enthusiasm.
• 42% of failed startups had no market need before running out of capital, according to CB Insights.
• Product-market fit is necessary but incomplete. Market-product fit means buyers can describe your category without your help.
• The first signal of real startup traction is when clinicians adopt your language without being educated by your sales team.
• Ray Cohen at Axonics hit 20 consecutive profitable quarters before a $3.7B acquisition by Boston Scientific because he engineered a market, not just a product.
• The purpose of startup traction is not to celebrate. It's to raise the next round and stay in the game long enough to build something durable.

Why Investors Keep Saying Come Back When You Have More Traction

You've crossed the FDA finish line. Physician champions are telling colleagues your device changed their practice. Revenue is coming in. And investors are still saying "come back when you have more traction."

Because what you have is activity. And activity is not startup traction.

The purpose of startup traction is not a celebration milestone. I covered this directly on a recent episode about what market engineering produces and proves:

Traction is not revenue or product launch or clinical milestones. Traction is repeatable, measurable demand.

Revenue can be episodic. One great quarter doesn't prove repeatability. One enthusiastic surgeon doesn't prove a market.

Investors have seen too many cleared medtech devices close three deals and call it commercial success, then stall because every subsequent deal requires the same founder-led education cycle.

The diagnostic is this: if every deal still requires you to explain the problem from scratch, you don't have startup traction. You have a very early product in search of a market.

CB Insights tracked what caused startups to fail. The number one reason was running out of money.

The leading indicator that predicted it: a little over 40% of those startups had no real market need. Not a bad product. No market. And in medtech, "no market" often means the founder never made one.

Why Product-Market Fit Is the Wrong Framework for Medtech Founders

Most founders have heard of product-market fit. I'd argue it's incomplete for medtech.

Product-market fit assumes the market already exists. You build a product, find the market that fits it, and plug in. But in medtech, either the market doesn't exist yet at clearance or the buying criteria are set by an incumbent. Both cases mean you're playing by someone else's rules.

On that same episode, I made the case for inverting the sequence:

Product market fit is necessary, but it's incomplete. Market product fit means that the market understands three things: problem, category, approach. The market will compare you incorrectly, commoditize you, or ignore you entirely if you don't figure this thing out.

Market-product fit asks a different question. Not "does this product fit a market?" but "does this market understand the problem the way we do?"

If clinicians can't articulate why your device exists, in their own language, without your team coaching them, the market is not made yet.

And if the market is not made, what you have is not startup traction. It's clinical curiosity.

The companies that confuse the two run out of runway before they figure out the difference.

What Real Startup Traction Looks Like in Medtech

I've interviewed over 370 founders and commercial leaders on State of MedTech. The ones who built fundable, acquirable companies all describe the same inflection point. There's a moment where they stopped pushing and started being pulled.

Here's what that shift looks like in practice:

Traction starts first when people in your market start using your language. Real traction is showing up as consistent conversion, shorter sales cycles, and reduced need for education. The demand becomes pull-driven.

Three measurable signals. Consistent conversion from interest to commitment. Sales cycles shortening without more sales reps. Each deal requires less education.

If you can't point to all three, you have early adoption. That's not startup traction. That's permission to start building one.

There's a fourth signal that matters most: minimum viable category. When you've reached it, you can walk into a room of clinicians who've never heard of you and they'll already describe the problem the way you do.

The category really defines how your product is evaluated. When you've achieved minimum viable category, different stakeholders start to describe the problem and your category using similar language without your help.

This is when startup traction becomes fundable. The market is evaluating you on criteria you defined. Not on someone else's terms.

Understanding how category design in medtech determines evaluation criteria is what separates the companies that raise from the ones that stall despite real clinical results.

How Axonics Built 20 Consecutive Profitable Quarters Before the $3.7B Exit

Ray Cohen at Axonics didn't just find product-market fit. He engineered a market from clearance to category leadership over years of deliberate sequencing.

The result was 20 consecutive profitable quarters and a $3.7B acquisition by Boston Scientific. I covered the full story in my conversation with Ray Cohen at Axonics.

The short version: Ray understood that early clinical adoption was not startup traction. It was an invitation to start building one. He spent years on category creation before scaling the sales team.

By the time Axonics hit commercial scale, the market was pulling toward them. Deals were closing faster. Education cycles were shorter. Buyers were calling Axonics, not the other way around.

That's what 20 consecutive profitable quarters looks like from the inside. Not a lucky streak. A market that was engineered before it was sold.

Traction got Axonics into the game. Category control kept them there until the right exit.

What This Means for Medtech Founders

In my experience working with early-stage medtech companies, the startup traction conversation usually surfaces around Series B prep.

A founder walks in with $3M ARR, a handful of clinical sites, and a deck that says "commercial traction achieved." Investors look at the sales cycle length, deal conversion rate, and ask how many deals required the CEO to close. The answer ends the meeting.

Investors aren't questioning the revenue number. They're questioning what the revenue signals. Episodic deals signal a market that still needs to be made. Repeatable deals with shortening cycles signal a market that is being pulled.

Adding reps won't close that gap. The question to answer first: has a category been defined that the market can evaluate without a founder in the room?

If not, that's the work. Category before pipeline.

Two places to start: read how the medical device go-to-market strategy sequences market engineering before sales headcount, then trace how the category design framework produced fundable results for Bruce Cleveland's portfolio companies.

The pattern is consistent across every fundable exit I've studied. Market engineering precedes commercial scale. Every time.

Frequently Asked Questions

What Is Traction in Business?

Traction in business means repeatable, measurable demand that exists without constant founder-led education. It shows up as consistent conversion rates, shortening sales cycles, and buyers coming inbound rather than being chased outbound.

Revenue alone is not traction if each deal requires starting the sales education from scratch. Traction is the market pulling toward you.

What Does Startup Traction Mean for Medtech Companies?

Startup traction in medtech means your market has validated the category, not just the product. Clinicians describe the problem using your language without prompting. Sales cycles are shortening without adding reps.

Conversion from first meeting to commitment is becoming predictable and repeatable. These are the signals investors and acquirers are looking for when they say "come back when you have more traction."

How Is Market-Product Fit Different From Product-Market Fit?

Product-market fit means your product solves a problem in an existing market. Market-product fit means the market understands the problem the way you defined it, uses your category language without coaching, and evaluates competitors against criteria you set.

In medtech, where most categories do not exist at clearance, market-product fit is the harder and more fundable target.

How Do You Build Startup Traction in Medtech?

Building startup traction in medtech starts with category creation before commercial scale. Define the problem in language clinicians adopt on their own.

Build a minimum viable category where the market understands the "why" before your sales team explains the "what." The signal that it's working: deals start closing faster, education cycles get shorter, and buyers start calling without being prompted. That's pull-driven demand. That's startup traction.

Listen to the Full Episode

Omar's full breakdown of startup traction, market-product fit, and the market engineering framework is available on The State of MedTech. Watch on YouTube. 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.