Seven GTM Lessons From a Founder Who Spent 10 Years Building Before Raising VC

Your son asks if he can hide in your suitcase so he can travel with you. That’s when you know your go-to-market strategy isn’t working.

In a recent episode of Category Visionaries, Vijay Sikka, CEO and Founder of Sikka, a retail healthcare technology platform that’s raised over $30 million, shared the hard-earned lessons from building a company that now serves 45,000 practices with just 45 employees. His journey—from working as an office manager in his wife’s dental practice to processing a billion transactions daily—offers a masterclass in unconventional GTM strategy.

These seven lessons challenge Silicon Valley’s standard playbook and provide a framework for building in fragmented markets.

Lesson 1: Distribution Is Harder and More Valuable Than Product-Market Fit

Most founders stop celebrating after achieving product-market fit. Vijay argues this is precisely backwards.

“The way I look at entrepreneurship is three hacks,” Vijay explains. “The first hack is product market fit. The second hack is distribution, which is kind of go to market. And the third hack is people.”

The critical insight: “Product market fit is great, but you know, that’s just the first step, distribution. How do you get your product out there? How does, how does the product expand? That’s the second hack. And that in my opinion is really way more valuable and harder to do than the first hack, which is the product market fit.”

This reframes the entire startup journey. Product-market fit is table stakes. The real competitive advantage emerges in how you distribute that product. Companies that treat distribution as an afterthought—something to figure out after building the perfect product—miss the opportunity to embed distribution into their business model from day one.

Lesson 2: Direct Sales Doesn’t Scale in Fragmented Markets (No Matter How Much You Raise)

Vijay learned this lesson the painful way. In the early days, he spent three days out of every five on the road, traveling to study clubs and doctor groups. His young son’s request to be packed in a suitcase captured the unsustainability of the approach.

“I remember my kid was like 4 or 5 years old at that time. He used to say, hey dad, could you put me in a suitcase and take me with you? Because I would be out on the road all the time.”

The economics simply didn’t work. Sikka faced 250,000 independent practices across dental, veterinary, and optometry markets. The math was brutal: “We realized was direct sales and direct one one is really not the best approach because you could probably be raising 100, $200 million and still not be able to get to this highly fragmented market.”

Even $200 million wouldn’t have been enough to build a sales force capable of reaching this market effectively. The fragmentation made traditional enterprise sales impossible and SMB sales too expensive. This realization forced a fundamental rethinking of distribution strategy.

Lesson 3: Infrastructure Can Become Your Sales Force

The breakthrough came from studying companies like Twilio, Stripe, and MuleSoft—companies that turned infrastructure into distribution.

Vijay built an API platform connecting to 450 practice management systems, creating what he calls “build once, deploy everywhere” infrastructure. This took ten years. No shortcuts. No venture capital pressuring for faster growth. Just methodical infrastructure building.

The payoff transformed distribution entirely. “We have some of the biggest names in the industry. Dental, veterinary, optometry, for reputation management, revenue cycle management, payments, business performance management. All of them are using our platform in order to run their applications.”

Every software vendor that needed to reach the fragmented retail healthcare market had to integrate with Sikka’s platform. And every integration became a distribution channel: “Because all the doctors, when they approach the doctor, they bring the doctor to our marketplace. The doctor signs the C. AI paperwork, business associate agreements, and then starts to get that service. So you see how our distribution is built into our business model.”

The platform itself forces distribution. Partners can’t sell their solutions without bringing customers to Sikka’s marketplace. Distribution became automatic, embedded in the product architecture.

Lesson 4: Technical Moats Take Time But Create Unassailable Advantages

“It took us 10 years plus to build all the connections to 450 practice management systems,” Vijay notes. Ten years is an eternity in startup time. Most founders would have pivoted, raised capital, or found shortcuts.

But the investment created a competitive advantage that’s nearly impossible to replicate: “If somebody else tries to do it’ll take them six to eight years trying to just get to connections that we already have built. And we are running as fast as we can.”

Six to eight years is a lifetime in technology. By the time competitors build equivalent infrastructure, Sikka will have extended their lead. This is the power of infrastructure moats—they compound over time, making the gap wider rather than narrower.

The key insight: in fragmented markets, comprehensive infrastructure becomes more valuable than product innovation. Once you’ve solved the integration problem, you own distribution.

Lesson 5: Bootstrap Until Your Moat Is Built

Vijay’s approach to fundraising contradicts standard Silicon Valley wisdom. Instead of raising venture capital early and burning through it to build quickly, Sikka bootstrapped for over a decade.

“Initially we thought honestly that we’ll just build a bootstrap business. But then as we started to grow and once we started to see that the opportunity is or to build a platform and optimize an entire industry, which being retail, healthcare, this dental, veterinary optometry, we said the best way to do that is to bring really professional investors.”

The company only approached institutional investors in 2016-2017, after building connections to 450 systems and reaching critical mass in market penetration. By then, the business model was proven, the moat was built, and investors were buying into inevitable success rather than unproven potential.

“We kept growing organically by servicing our customers. We kept growing our install base,” Vijay explains. This organic growth funded the infrastructure build, creating a self-sustaining flywheel before venture capital entered the picture.

When Sikka finally raised capital, they did so from a position of strength—with the technical moat already built and distribution already embedded in the business model.

Lesson 6: Consolidation in Fragmented Markets Creates New Distribution Channels

Within the broader market fragmentation, Vijay identified a consolidation trend: dental service organizations backed by private equity were aggregating independent practices into larger groups.

“A large number of practices have started to consolidate or be consolidated into groups of practices,” Vijay notes. These DSOs, “sometimes multibillion dollar publicly traded companies,” faced a unique problem.

“They may have offices all over the geographic locations within the United States. They may have different practice management systems at each location. And they really cannot transform, convert all those practices into the same practice management system because it’s really hard and it takes too much commitment and it takes two years or so to convert.”

Converting practice management systems meant stopping revenue for two years—an impossible proposition. “You cannot really stop the mother’s milk, right? I mean, you got to make sure that the practices are continuously working and the revenue generation is happening.”

Sikka’s platform solved this by sitting on top of heterogeneous systems. One DSO contract meant hundreds of practices—sales efficiency that dramatically accelerated growth while maintaining the small team structure.

Lesson 7: Stay Lean Even While Scaling

Perhaps the most remarkable aspect of Sikka’s story is the numbers: 45,000 practices, 150 million patients, a billion transactions processed daily, 90%+ recurring revenue, 110% net dollar retention, EBITDA profitability, and 40-45% annual growth.

All with 45 employees.

“The company is not a giant in the sense that you lose your sense of identity, you still understand how to run how the business works. And that, I think, really appeals to the entrepreneurial team members who want to join us to learn how to grow.”

This isn’t about staying small for the sake of being small. It’s about recognizing that the right business model—with infrastructure doing the work of distribution and partners functioning as the sales force—doesn’t require massive headcount.

The economic efficiency speaks for itself: 80%+ gross margins, EBITDA positivity, and growth rates that most venture-backed companies would envy, all while maintaining profitability. “We are EBITDA positive and we are actually really enjoying. We have our first year of profitability this year,” Vijay shares.

The Contrarian Path

These seven lessons form a coherent strategy that contradicts almost every piece of standard Silicon Valley advice. Don’t raise early. Spend a decade building infrastructure. Abandon direct sales in fragmented markets. Let partners become your sales force. Stay lean even while processing massive transaction volumes.

Yet the results validate the approach completely. When venture capital finally entered in 2016-2017, investors found a business with unassailable moats, embedded distribution, and a path to profitability that didn’t require burning hundreds of millions of dollars.

For founders facing fragmented markets, Sikka’s journey offers an alternative playbook—one where patience, infrastructure, and embedded distribution create advantages that no amount of venture capital can buy.