There is a pattern I have seen more than once in medtech.
Posted on September 7, 2026 by Sunny Singh
There is a pattern I have seen more than once in medtech.
A company gets its device cleared. The founders and a few well-connected salespeople land the first customers. There is real excitement. Then growth starts to get harder.
The pipeline is not developing quickly enough. Salespeople are telling the story differently. The website suddenly feels inadequate. Competitors seem more visible. The board starts asking what marketing is doing.
So the company hires a marketing manager.
A year later, there is usually a better website, more polished collateral, a trade show calendar and a steady stream of LinkedIn posts.
A year later, there is usually a better website, more polished collateral, a trade show calendar and a steady stream of LinkedIn posts.
But the underlying commercial problem is often still there.
The issue was not necessarily the person they hired. It was that the company hired marketing to solve the wrong problem, at the wrong time, with the wrong job description.
That is what makes marketing hiring in medtech different from hiring marketing at a typical software company. You cannot simply wait until you hit a certain revenue number and decide it is time to build the function.
Some of the most important marketing decisions in a medical device company happen years before meaningful revenue shows up.
There is plenty of startup advice that tells founders when to hire marketing based on revenue.
Hire your first marketer at $2 million. Add a director at $10 million. Bring in a VP at $25 million.
That may be useful shorthand in SaaS. I would be careful applying it to medtech.
A medical device company makes enormous commercial decisions before it has much revenue at all.
Those may sound like clinical, regulatory or product questions. They are. But they are also market questions.
And once those decisions are made, they become very expensive to unwind.
By the time a device company reaches $5 million in revenue, a surprising amount of its commercial future has already been constrained. The clinical evidence exists. The FDA-cleared claims exist. The indication exists. The reimbursement situation exists.
A marketer joining at that point cannot simply invent a more compelling story. They have to build one from the evidence and claims the company gave them.
That is one reason so many medtech marketing teams get reduced to producing collateral. They were brought in after many of the decisions that could have materially changed the commercial outcome had already been made.
A better question than “How much revenue do we have?” is:
Are we making important market decisions that will be difficult to reverse, and does anyone in the company actually own the customer and commercial side of those decisions?
If the answer is no, you probably need marketing capability.
That does not automatically mean you need a full-time employee.
Another common mistake is putting four different jobs into one job description and calling it “Head of Marketing.”
In reality, most growing medtech companies need some combination of four very different capabilities.
Upstream marketing is involved before the product is fully commercialized.
This is the work around market selection, segmentation, voice of customer, unmet needs, product requirements, indications and early commercialization strategy.
A strong upstream marketer may spend far more time talking to surgeons, administrators, R&D and clinical teams than thinking about campaigns.
Their job is partly to make sure you are building the right thing for a market that will actually buy it.
Downstream marketing takes what you have and helps the market understand, adopt and buy it.
This is where positioning, messaging, launch planning, sales enablement, congress strategy, digital marketing, campaigns and demand generation begin to matter.
It is much closer to the commercial organization and usually operates on a shorter time horizon.
Market access answers a different question:
Can anyone actually pay for this?
That can involve coding, coverage, reimbursement, health economics, budget impact analysis and the evidence needed to get through payer or health system scrutiny.
Market access often sits near marketing organizationally, but I would not assume a good product marketer can do it. The backgrounds and skill sets are quite different.
That is brand and market development. It can be difficult to attribute neatly, which is partly why early-stage companies tend to underinvest in it.
The important point is that one person is rarely excellent at all four.
Someone who has spent a career conducting surgeon research and shaping product strategy may not be the person you want building a digital demand engine.
A demand generation marketer coming out of healthcare SaaS may be fantastic at creating pipeline and completely lost when asked to build a reimbursement story.
Before you write a job description, figure out which problem is actually holding the company back.
That is the hiring decision.
Most pre-clearance medtech companies do not need a full-time downstream marketing person.
They do need marketing work.
There is a big difference.
Before clearance, I would rather see a company spend money answering a few difficult commercial questions than immediately start building a marketing department.
That last one is easy to miss.
It is painful to get to launch and discover that the question every hospital wants answered was never built into your trial.
A lot of this work can be done through a focused upstream marketing, market research or commercialization project. It does not necessarily justify another full-time salary.
Meanwhile, hiring a junior marketer too early tends to create exactly what you would expect a junior marketer to create: a website, brand assets, social posts, event materials and general marketing activity.
Those things have value.
They just may not be the highest-value work at that stage.
There is an important exception. If the company is creating an entirely new category, introducing a new procedure or trying to change entrenched clinical behavior, market development may need to begin years before launch.
You cannot campaign your way into category creation six months before clearance.
Once the device is cleared and the company begins selling, the symptoms become louder.
But if the company has never clearly answered why the product matters, for whom and against which alternative, adding more execution simply spreads the confusion faster.
For many device companies, the first true commercial marketing hire should be a strong product marketer who understands clinical evidence.
A good medtech product marketer can build the connective tissue between clinical evidence, positioning and the field.
They should be able to answer questions like:
That person tends to be more valuable early on than someone whose primary skill is running campaigns.
One of the fastest ways to tell whether somebody truly understands medical device marketing is to listen to how they talk about claims.
Medtech marketers do not get to write whatever sounds best.
Promotional claims need to fit within the device’s cleared or approved use. They have to be supportable. Materials typically move through medical, legal and regulatory review before they reach the market.
That changes how marketing works.
A marketer coming from an unregulated industry may write brilliant copy that never makes it through review.
After enough rounds of that, one of two things tends to happen.
Either everything becomes painfully slow, or the marketer starts writing so conservatively that the messaging becomes indistinguishable from every competitor’s.
It is also why I would ask a medtech marketing candidate a very specific interview question:
Tell me about a claim you wanted to make that regulatory rejected. What did you do next?
A strong answer tells you a lot.
It shows whether the person understands evidence, whether they know how to work with regulatory rather than treating them as the enemy, and whether they can find a better way to tell the story without crossing the line.
This is probably one of the more expensive mistakes a device company can make. The CEO sees deals stalling and assumes the answer is more marketing. But clinicians already understand the product.
If the physician loves the product and the deal consistently dies once finance, reimbursement or administration gets involved, start looking at market access.
That work should often begin earlier than companies expect, sometimes while the clinical study is still being designed.
The evidence FDA needs and the evidence a payer or hospital committee wants are not always the same.
You would much rather discover that before the study ends.
Early on, market access is also a good example of a capability that may make more sense to buy than hire. The work can be highly specialized and milestone-driven. A company may desperately need senior expertise without needing that expertise 40 hours every week.
The important thing is simply that someone owns it.
This seems like an org chart question.
It is really a question about what you expect marketing to do.
If marketing exists primarily to support sales, build materials, coordinate events and respond to field requests, reporting to the VP of Sales can work perfectly well.
Just be clear about the job.
Where companies run into trouble is hiring a senior strategic marketing leader, putting them under sales and then wondering why they are spending most of their time responding to sales requests.
That structure naturally pulls marketing toward the current quarter.
The sales leader is responsible for this quarter’s number. Of course the opportunity that could close next month is going to feel more urgent than positioning work that may shape the next three years.
If you want marketing involved in market selection, evidence strategy, positioning, product decisions and long-term demand creation, the role needs enough organizational authority to do those things.
In many growth-stage companies, that means marketing should have a direct relationship with the CEO and a real seat in leadership discussions.
Otherwise, do not be surprised when the strategic marketing hire slowly turns into the sales enablement department.
I think companies make this decision harder than it needs to be. Start by asking what you are actually missing.
A fractional senior marketer can make sense here because the company needs experienced judgment, but may not need it 40 or 50 hours every week.
There is also a very real failure mode with fractional teams. It has become relatively easy to build a company around a fractional CMO, a freelance designer, an agency, a PR firm and three specialists.
Suddenly seven people are involved in marketing and nobody actually owns marketing. Fractional works best when accountability is very clear.
The salary is the easiest part to see. It is not usually the most painful part.
A senior marketer can take months to fully understand the clinical environment, evidence, customers, regulatory limitations and buying process.
Now imagine the hire is wrong.
That hurts more in medtech than it does in many categories because the sales cycles are already long.
If a health system opportunity takes a year or more to move from initial interest to a purchase decision, losing a year internally can mean losing an entire buying cycle externally.
This sounds obvious until you look at the scorecards companies use. A marketer joins in January. By September, the CEO wants to know how much closed revenue marketing generated. Meanwhile the average health system deal may take 12 months or longer. That is not accountability. It is measuring the wrong thing at the wrong point in the cycle. Different marketing jobs need different measures.
An upstream marketer should be judged partly on the quality of the insight going into market, product and evidence decisions.
A demand generation marketer should be judged on the quality of pipeline they create and their penetration into the accounts the business actually cares about.
A hundred leads from people who cannot buy the device are not more valuable than ten conversations inside target health systems.
And then there is brand.
Some of the most important signals in medtech are difficult to put into a dashboard.
A mature marketing organization has to be able to do both: measure the things that can be measured rigorously without pretending that everything valuable can be tied neatly back to a single source.
A few things are changing the way I would think about building a medtech marketing team over the next several years.
The first is capital efficiency.
Investors are paying far more attention to whether a company can actually commercialize what it has built. Having compelling technology is not enough. Companies increasingly need to demonstrate that they understand the customer, can move through the buying process and have the beginnings of a repeatable commercial motion.
That puts pressure on companies to develop commercial capability earlier.
The second change is how buyers research.
For years, companies could afford to keep a huge portion of their real value story inside the sales deck.
That is getting harder to justify.
Clinicians, executives and buyers increasingly encounter companies through Google, AI-generated search results and answer engines before they ever speak to a rep.
If your useful clinical evidence, economic story and point of view are invisible outside of a sales presentation, the market has very little to discover.
This does not mean every medtech company suddenly needs an “AI marketing expert.”
It means downstream marketers increasingly need to understand how information gets discovered, interpreted and cited before a sales conversation ever happens.
The third shift is the growth of fractional and project-based senior talent. Companies have more options than they used to.
A $10 million medtech company can get access to someone who has launched multiple devices without necessarily hiring that person as a full-time executive.
That is useful.
It also creates an accountability problem if the company simply assembles a collection of specialists and assumes somebody else is connecting the dots.
Someone still has to own the commercial story.
When a CEO asks me, “Who should I hire in marketing?” I think there is a better question to ask first:
The marketing hires that go badly are often the ones made because the company feels like it “should have marketing by now.”
Do not base the decision entirely on revenue.
Marketing capability should enter the business when the company starts making consequential market decisions and nobody clearly owns the customer and commercial perspective.
For many companies, that means using upstream marketing expertise before FDA clearance without necessarily making a full-time hire. The first full-time commercial marketing hire often makes more sense as the company approaches launch or begins generating early revenue.
Upstream marketing helps determine what should be built, for whom and why. It usually includes segmentation, market research, voice of customer, unmet-needs work, product requirements and commercialization planning.
Downstream marketing takes a product into the market. It includes positioning, messaging, launch planning, sales enablement, demand generation, digital marketing and congress strategy.
They overlap, but they are different disciplines and often attract people with very different strengths.
Look at what is missing.
If the company needs senior commercial judgment but does not yet have enough work or budget to support a full-time executive, fractional leadership can make sense.
If the company already knows what it needs to do and simply lacks the people to execute it, hire or contract for execution instead.
A fractional executive should not become an expensive substitute for a marketing team.
It depends on the mandate.
If marketing primarily supports field sales, reporting into sales can work.
If marketing is expected to shape market selection, positioning, evidence strategy and long-term demand creation, it generally needs stronger access to the CEO and leadership team.
The reporting structure should match the job you expect marketing to perform.
Look at where deals are stalling.
If clinicians understand the device, want it and are advocating for it, but deals repeatedly stop once reimbursement, finance or administration gets involved, the problem may be market access rather than marketing.
That can mean coding, coverage, payment, health economics or the hospital’s ability to justify the purchase.
More promotion will not solve an economic problem.
There is no particularly useful single number because titles vary enormously across companies.
A “marketing manager” may be a tactical generalist at one company and effectively a senior product marketer at another.
When budgeting, look beyond salary and account for benefits, payroll costs, recruiting, ramp time and the level of medtech experience the job actually requires.
Specialized experience in areas such as medical devices, product marketing, regulatory review and commercialization typically commands a premium over a general marketing hire.
The biggest cost is usually time.
A poor fit can take months to identify, several more months to replace and another long ramp period before the replacement understands the clinical evidence, regulatory environment, buying process and sales organization.
In medtech, losing 12 months internally can mean losing an entire health system buying cycle externally.
Measure them against what they can reasonably influence.
For a product marketer, that may include field readiness, messaging adoption, sales confidence, objection handling, deal progression and the quality of value analysis materials.
For upstream marketing, it may be the rigor of customer insight and the quality of the market decisions that follow from it.
For demand generation, look at qualified pipeline and penetration of target accounts rather than raw lead volume.
Closed revenue matters eventually. It just should not be the only way you decide whether marketing is working.
If you are trying to decide what your next marketing investment should be, start with the commercial constraint rather than the job title.I work with medtech companies as a fractional CMO, helping leadership teams figure out what needs to be built internally, what can be bought externally and what the commercial organization actually needs before adding more marketing activity.
If your positioning, your campaigns, and your reporting need to work as one system, and you want someone who's built that inside healthcare before, let's talk.
Book a 20-minute discovery call