Designing a MedTech Sales Compensation Plan, From Rep to VP

A sales compensation plan does two jobs. It tells your team what the company values, and it decides whether the best people stay. In MedTech, getting it right is harder than in most industries: sales cycles are long, buying decisions involve clinicians, purchasing and value analysis committees, and a representative's results depend heavily on the territory they inherit.

The terms that matter

• Base salary: the fixed portion of pay.
• Variable pay: commission or bonus tied to results.
• On-target earnings (OTE): base plus variable at 100% of goal. It's the number candidates compare offers on.
• Pay mix: the split between base and variable at target, written as base/variable, such as 60/40.
• Quota: the goal the variable pay is measured against, in revenue, units or growth.
• Accelerators: a higher commission rate above quota, to reward overperformance.
• Thresholds: a minimum attainment before variable pay starts.
• Caps: a limit on total variable pay. In sales roles, caps tend to drive top performers away.
• Clawbacks: the right to recover commission on business that's later reversed.
• SPIFs: short-term incentives for a specific product or behavior.
• Ramp guarantees: guaranteed variable pay for a new representative's first months, while they build a territory they didn't create.

How pay changes by level

FloodGate's 2026-2027 MedTech Compensation Guide shows how the mix shifts as roles move from individual selling to leadership. Averages from the guide:

Two things stand out. Representatives earn more than half of their pay from variable, so their plan shapes behavior more than any other role's. And, as the guide notes, a high-performing representative can out-earn their regional manager when commissions are uncapped or the territory is strong. That's normal, and worth explaining to managers before it surprises them.

Plans by role

Territory representatives

Representatives own revenue directly, so variable pay is the largest part of their OTE. Commission is usually paid on revenue or units against a territory quota, with accelerators above plan. Points to settle up front:

• Capital versus disposables: a capital sale and the disposables that follow it behave very differently. Decide how each is credited.
• Shared credit: clinical specialists, national accounts and capital teams often touch the same deal. Define split credit before the first dispute.
• Territory changes: decide how quota and credit move when territories are redrawn, and what happens to house accounts.
• Ramp: a guarantee for the first months makes it possible to hire experienced people away from established territories.

Clinical specialists

Clinical specialists support procedures and drive adoption, but they usually don't own the sale. Plans tend to weight base more heavily, with a bonus tied to territory or team results and to measures such as case coverage, physician training or utilization.

First-line sales managers

Regional managers earn on their team's results, usually with a higher base than their representatives and a bonus on team attainment. Add measures for the things only a manager can do: hiring, ramping new representatives and keeping good ones.

Directors and VPs of Sales

At the top, base becomes the larger share of pay, and variable is tied to the company's commercial plan: revenue, growth, margin or cost of sales, sometimes with milestones such as a launch or a market entry. In venture-backed companies, equity is often a large part of the package and a key reason a leader takes the role. Keep the measures few, clear and in the leader's control.

Designing the plan

1. Start with the business goal. New account growth, adoption of a new product and protecting an installed base call for different plans.
2. Set the budget. Model total payout at low, target and high attainment, so you know what a great year costs.
3. Choose the mix by role. The more a role controls the sale, the more of its pay should be variable.
4. Set fair quotas. Base them on territory potential, not just last year's number plus a percentage. Unreachable quotas are the fastest way to lose people.
5. Keep it simple. If a representative can't calculate their own commission, the plan isn't working.
6. Review it every year. Markets, products and territories change, and the plan has to change with them.

Common mistakes

• Capping commission. It tells top performers where to stop, and some of them will leave.
• Too many measures. Each one dilutes the others. Three is usually enough.
• Opaque payout math. Disputes over commission cost more in trust than they save in money.
• Ignoring the market. A plan that pays below market will struggle to recruit, however well it's designed. Check it against current MedTech pay data.

FloodGate Medical is a retained search firm specializing exclusively in MedTech, and our compensation guide is built from more than 4,300 data points. See how a search works.