Looking back: April 2026
One of the most durable lessons I took from selling into medical technology was this: your clinical champion will change roles before your deal closes. Not sometimes. Usually.
This is true in every industry — champions get promoted, move sites, leave. But medtech has a particularly high rate of internal rotation. Clinicians shift sub-specialties. Hospital systems reorganize. Academic physicians move between institutions. The cadence is faster than in most B2B contexts, which made medtech a reliable teacher about multi-threading.
The Pattern
A typical medtech enterprise cycle runs 6 to 18 months. A clinical champion’s seat in a specific role at a specific institution is often 18 to 36 months. Do the math on overlap and you realize: in a non-trivial percentage of deals, the person who championed you at month one is in a different role by the time your deal is operational.
I saw this go sideways on specific deals. A surgical champion who was thrilled in the discovery phase got recruited to a different hospital system at month five. His replacement had a different preferred vendor. The deal didn’t die — it just stopped moving, and nobody could tell me why for three months.
Another deal — an internal medicine champion got pulled into an administrative role mid-cycle. She wasn’t moving institutions. She was just moving offices, and the new role didn’t include authority over clinical purchasing. The deal required a new champion, whom we had never met.
What I Learned About Building Deals
The first obvious lesson: multi-thread everything. In medtech, this meant cultivating at least three clinical relationships on a given deal, plus administrative, plus materials management. No single-threaded deal survived contact with institutional reality.
The less obvious lesson, the one that took me longer: build relationships with people who will outlast any specific role. The senior clinicians who remained in an institution for decades were worth more than a junior champion in the current buying center. A dean, a department chair, a longtime nursing director — their presence was stable across reorganizations.
I started building relationships at those levels even when they weren’t directly involved in my deals. Two years later, I’d find that one of them had become the sponsor I needed on a deal I hadn’t even started yet.
Why This Applies Everywhere
Medtech taught me the pattern, but I’ve since watched it play out in every industry:
- In telecom, CIOs rotate between business units every 3 to 4 years. The relationships with their VPs — who often stay longer — outlast them.
- In construction, project managers change but the owner’s representative often stays for years. Build that relationship and you have durable access.
- In consulting, the engagement manager on any specific project will rotate. The senior partner sponsoring the client relationship rarely does.
The common pattern: in any enterprise selling motion, there are transient relationships and durable ones. The transient ones drive individual deals. The durable ones drive careers.
The operators I’ve watched build the strongest enterprise selling records were the ones who invested in durable relationships even when they didn’t need them for the current deal. The ones who invested only in transient relationships had bursty results — strong when the specific person was in place, invisible when they moved.
The Principle I Now Apply
In every account I work, I try to answer one question explicitly: who, at this account, will still be there in five years?
The answer is sometimes the obvious senior executive. Often it’s someone adjacent to the buying center — a longtime operations director, an influential technical lead, a specialist who’s built a career at the institution. These people are often not the deal decision-maker in the current cycle. They are the decision-makers across decades.
Medtech made this legible because the rotation was so frequent that the lesson arrived early. Every industry has the same pattern. It just compresses or expands the timeline on which the lesson becomes obvious.
Looking back, the reason I still emphasize multi-threading so heavily — in content, in coaching, in deal reviews — is that medtech taught me, early, how expensive single-threading is in an industry where people move. The insight generalized. The urgency came from the compressed laboratory of clinical sales.
If you’re selling into any industry with high role rotation — and most B2B industries qualify — the multi-threading lesson is the same lesson medtech teaches. Learn it early or pay for it later.