Some 25 years ago, while working for Enterprise Rent-A-Car, I rented a car to a guy who told me he went into hospitals and operating rooms with surgeons and sold them the equipment they used to fix their patients. Needless to say, I was blown away. I had never heard of such a thing, but I knew that I had to find a way to do what he did.

The catch: I had a Fine Arts degree, a limited business background and no biotech or science experience. Just a genuine fascination with an industry I knew nothing about and enough desire to figure it out anyway.

Back then, there was no resource for learning how this industry worked or for breaking into it. I got lucky. A second cousin's husband had sold surgical hardware, which led me to his daughter's podiatrist husband, who gave me the name of a medical distributor that he worked with. Twenty phone calls later, she finally answered and said she didn’t have much, but I could sell some orthopedic pins and screws for her. Straight commission. The most formal training I got was a handful of VHS tapes (you youngsters out there, feel free to Google that) and the sage advice of "don't cross the red line without being in scrubs." What red line, and where it might be, I had no idea. I learned by trial and error, found many great people willing to help along the way. My first paycheck was $280 for a month's work. But it was a start to what would become a great career.

Eventually, I landed at Smith & Nephew, where I became the number one sales rep in the country. From there, I moved into marketing, traveling the world and working alongside surgeons and industry professionals worldwide. Today, I work as a senior industry analyst with SmartTRAK, where medical device companies pay for my insights into surgical sports medicine.

This newsletter is the product of all of that experience, and what I wish had existed when I was starting out. It covers what this industry is, what's happening in it right now, the different paths you can take, and maybe a few stories worth learning from. I hope you get a lot out of it.

Glad you're here.

Andy Knapik, Founder

The Modern Med Rep

Here's a plain-language overview of the major segments, what makes each one different commercially, and why any of them might be worth your attention.

Cardiovascular and Electrophysiology.

One of the most clinically intense segments in med device. Reps in this space work directly with interventional cardiologists and electrophysiologists in cath labs and electrophysiology suites, often supporting complex procedures in real time. The knowledge bar is high, the relationships are deep, and the compensation reflects both. Pulsed field ablation is currently reshaping the EP space in a way that hasn't been seen in years.

Orthopedics.

Historically one of the most rep-driven segments in the industry. Orthopedic reps build intense, long-term relationships with surgeons and often scrub into joint replacement, spine, and trauma cases. The segment is mature in total joints but experiencing significant disruption from robotics and navigation technology. Sports medicine and upper extremity remain strong growth areas. Compensation is heavily commission-driven and can be substantial for reps with strong surgeon followings.

Diagnostics and Oncology.

A segment undergoing rapid transformation. The commercial model here is different from surgical device: less OR time, more emphasis on clinical data, health economics, and outcomes conversations with pathologists, oncologists, and hospital administrators. Abbott's $21 billion acquisition of Exact Sciences signals where the big players see the next decade of growth. For people coming from pharma or clinical backgrounds, this segment offers one of the more accessible entry points into device.

Digital Health and Connected Devices. 

The newest commercial frontier in med device. Wearables, remote patient monitoring, smart implants, and AI-powered diagnostics are creating an entirely new category of products, and with them a new kind of sales conversation. Reps in this space often sell both hardware and software subscriptions, which changes the economics and the customer relationship. This is where a lot of the venture capital and M&A activity is flowing right now.

Based on current hiring activity across the industry, here's where many opportunities are concentrated in mid-2026.

There's a number that should reframe how you think about where this industry is heading: 80%. That's the share of all U.S. surgeries now performed in outpatient settings. The hospital operating room, long the center of gravity for medical device sales, is no longer where most of the action is.

As of mid-2025, there were 12,294 ambulatory surgery centers operating nationwide, with over 6,500 Medicare-certified. The U.S. ASC market is valued at roughly $46 billion and is projected to grow 21% over the next decade. Procedure volumes are forecast to hit 109.6 million cases by 2033. And the two specialties with the highest anticipated growth inside ASCs are cardiovascular and orthopedic: the same two segments that drive the most device sales volume in the country.

The economics driving this shift are hard to argue with. Procedures performed in hospital outpatient departments cost up to 58% more than the same procedure at an ASC. Patients who choose an ASC save an average of $684 per procedure out of pocket. ASCs collectively reduce Medicare expenditures by $2.3 billion per year. Over 65% of insurers now actively prefer ASC-based procedures. Payer preference, patient preference, and cost pressure are all pointing in the same direction.

What makes ASCs commercially different from hospitals goes beyond the setting. ASCs operate on tighter margins and make faster purchasing decisions. There are fewer layers of administration between the rep and the decision-maker. The surgeon often has a direct financial stake in the facility, which changes the conversation about cost, efficiency, and outcomes in ways that don't apply in a hospital system. And because ASCs run leaner, the rep who shows up prepared, understands the economics, and can support a case efficiently without hand-holding is far more valuable than one who learned to sell exclusively in a large hospital environment.

Every major robotics company has identified ASCs as a primary growth battleground precisely because they represent untapped high-volume surgical opportunity. Medtronic, Stryker, CMR Surgical, and Intuitive are all actively building ASC-specific commercial strategies. The person who understands physician-owned facility dynamics, speaks the language of cost-per-case economics, and can navigate a leaner purchasing process has a skill set that's in genuine short supply right now.

This newsletter runs on real questions from real people building careers in med device. Every issue, one question gets a real answer.

Here's the one I hear most often:

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