Cover Story: A Page from Ray Cohen’s Playbook: Scaling, Exiting, and Winning in Medtech

With four decades of company-building, IPOs, boardroom leadership, and monumental exits behind him, Raymond W. Cohen has become one of medtech’s most successful operators. But behind the financial wins — including the recent back-to-back $3.7 billion Axonics and $600 million SoniVie acquisitions by Boston Scientific — is a deeper story of Cohen’s contrarian, full-transparency, people-centered, no-BS approach to leadership and strategy.

“People crave inspired, authentic, and transparent leadership that thinks big and acts boldly. They want to be enrolled in a vision of what is possible, and be recognized and compensated for creating measurable results, not be fed a bunch of platitudes.”

A quote that is classic Ray Cohen — blunt, unapologetic, no-nonsense, and grounded in hard-won experience. With more than four decades in medtech, Cohen has done what many aspire to — build, lead, scale, and sell high-stakes, successful ventures with precision and zero fluff. Known for his no-BS, direct approach, Cohen has turned startups into gritty, focused, execution-driven teams that deliver real results — and big exits — by staying lean, investing in sales and marketing, moving fast, and operating with a ruthless clarity of purpose.

On the LSI USA ’25 stage in Dana Point this past March, in a discussion entitled “Building and Exiting Companies in Medtech’s New Post-Covid Financial Era,” with State of MedTech podcast host Omar Khateeb, and in a recent interview with The Lens, Cohen offered a glimpse into his personal playbook of successful strategies, best practices, and lessons learned. From growing up in a working-class immigrant household in Queens, NY, to leading back-to-back exits, including his crowning achievement, Axonics, sold to Boston Scientific for $3.7 billion (closed Nov. 2024), and SoniVie ($600 million, closed in May 2025 also to Boston Scientific), Cohen described that his approach, although at times boldly contrarian, has been simple: show up, go all in, execute relentlessly, share the wealth, and build something that actually helps improve patient’s quality of life.

The Axonics Playbook: Go Big, Hire the Right People, Don’t Look Back

Cohen served as the chief executive officer and member of the board of directors of Nasdaq-listed Axonics, an Irvine, CA-based medtech company developing best-in-class solutions for people with incontinence that he co-founded in 2013 and took public in late October 2018. Axonics ranked #1 on the Deloitte Technology Fast 500 and the Financial Times ranking of the fastest-growing companies in the Americas in 2021 and 2022.

Cohen retired from the company following the closing of the acquisition. He led the epic deal and got it over the finish line, leveraging the deep relationships and trust he had earned with the Boston Scientific leadership team, going back to his days as CEO of the renal denervation company Vessix Vascular, that he sold to Boston Scientific in late 2012 (prior to the failed pivotal SYMPLICITY HTN-3 trial debacle in 2014).

Axonics’ success can be traced back to brash, “Cohen-esque” choices made along the way. For one, following Axonics’ IPO in 2018, Cohen threw out the standard commercialization playbook. Instead of hiring a small team and scaling slowly, Axonics went all in.

“People asked me during the IPO roadshow, how are you going to deploy the funds? I told them, despite the fact that we are perhaps as much as a year away from FDA approval, I’m hiring 100 salespeople for the launch, I’m going to guarantee them $20,000 a month, and I’m going to train the hell out of them. After all, we are competing with Medtronic, the largest medtech company on the planet that has enjoyed a monopoly and a 20-year head start on us,” he says.

“We hired 30 or 40 clinical specialists as well. The team trained intensely for an average of six months, so much so that you could wake them up at three in the morning, and they could jump out of bed and sing the company song. A silly expression but it got the point across.”

A lot of people told Cohen that he’s crazy and that’s not the way it’s done.

“I said, ‘well, that’s a common theme that I hear, but that’s what we’re going to do. And when the bell rings after we secure FDA approval, we’re going to hit the ground running on day one.’ And that’s what happened. When we got the green light, we launched like a rocket.”

This blog is originally published here: https://www.lifesciencemarketresearch.com/insights/cover-story-a-page-from-ray-cohens-playbook-scaling-exiting-and-winning-in-medtech