How much runway is enough in 2026

Why 18 months no longer works

Healthcare sales cycles have lengthened, not shortened. A Series A raised for 18 months of runway routinely runs out with the next round of milestones still six months away. The result is a punishing bridge market.

The 30-month floor

For clinical AI, medical devices pre-clearance, and any company with a regulated go-to-market, we now advise founders to target 30 months of runway at each round. That is the honest interval between meaningful, financeable milestones.

Implications for round sizing

This will push seed rounds toward $5–8M and Series A rounds toward $20–30M for most healthcare companies. Founders should model this before they walk into a pitch and be prepared to defend it with milestone plans.

The founder-clinician partnership

The strongest teams we have backed pair a founder who has operated at scale with a clinician who is still practicing. The tension between the two is the point. The operator wants to ship. The clinician wants to be right. The product that emerges from that tension is better than either would have built alone.

Teams that hire the clinician as an advisor rather than a co-founder consistently underestimate how much clinical judgment their product has to encode.

Hiring the first ten

The first ten hires set the ceiling on everything that follows. In healthtech, we push founders to over-index on hires who have shipped in a regulated environment before, even if it means paying more or waiting longer. The velocity gain from a team that has already survived one audit is enormous.

The field notes

Across the last quarter we sat in on operating reviews with fourteen portfolio and prospective teams working adjacent problems. Three patterns kept surfacing. First, the teams that moved fastest were not the ones with the deepest research bench — they were the ones with the shortest feedback loop between a real clinical user and the roadmap. Second, the winners had unusually opinionated evaluation harnesses. Third, none of them treated regulatory strategy as a phase; they treated it as a running conversation with the product.

What follows is a longer look at what we saw, what we think it implies for founders, and where we are actively deploying capital and studio effort in the coming twelve months.

What we are watching from the studio

Inside the venture studio, we are prioritizing three build areas connected to this thesis: the workflow substrate under clinical AI (consent, provenance, routing, human-in-the-loop review); the measurement layer that translates model behavior into a claim a payer or regulator can act on; and the operational tooling for the specialty clinics and virtual-first practices that will be the first commercial buyers of the next wave.

We are less interested in another general-purpose copilot. We are more interested in the boring infrastructure that makes ten specialized copilots safe to run at once.