@ycombinator Group Partner & head of bio and healthcare Surbhi Sarna is going to tell her own story of 🩺 How I built a medical device company nVision Medical) and sold it for $275M it’s an incredible story of perseverance 📝 sharing my notes:

this talk is primarily targeted at healthcare and biotech founders - but the lessons are easily transferable to other domains! healthcare is an important space for @ycombinator and @snowmaker personally Surbhi joined YC recently to run their biotech investment division

today she'll tell her incredible story which starts in high school. she was writing a paper on Emerson, when she felt a sharp pain she blacked out from the pain and woke up in the hospital, which would be the first of many trips diagnosis: repeat complex ovarian cysts

rather than wait for long diagnosis, she went on a journey to start nVision medical she wanted to bring focus to womens' health

she studied science and engineering at uc berkeley and worked at companies with the objective of learning about ovarian cancer and why it's so hard to diagnose

she learned that 95% of the time, there are symptoms: pain, bloating, bleeding - overlap with benign conditions so it's hard to make the call on whether biopsy of a cyst is worth the risk

so instead, they can do an ultrasound but can't tell if it's cancerous or a blood test which is no better than a coin toss

there is a class of women who go through this process, who are faced with a difficult situation women like Angelina Jolie who have the brca mutation today those women are told that after 40, think about having your ovaries removed

but ovaries have a big impact on your health the chances of getting Osteoporosis, depress and cardiovascular diseases increases dramatically

she pitched to a male investor, who had little empathy but the numbers were dramatic: 600k cases of removal surgery every year 5 year survival rate is only 15%

she started a company in something else, but eventually realized that they could do a pap smear for ovarian cancer, done annually latest research showed that ovarian cancer is a misnomer and it was typically starting in the fallopian tube

she developed a way to take cells from the fallopian tube for deformities that started a multi year journey

you may not have an idea for your startup like her for her, her company found her if there is something that really upsets you, don't ignore it - lean into it it's fuel for when things get hard

if you don't have something that frustrates you? immerse yourself in a field that you care about if it's education, go to a school - shadow them until they show frustration, that's a clue

you'll uncover stories of people trying something and failing don't let that discourage you maybe if it's been tried 1000x times.. otherwise take it as a data point and keep going

when talking to customers - your customers need to think it's a good idea for her, she only knew cardiovascular surgeons but needed to talk to a gynecologist she only knew her own. tried to call them, pitched the idea but got hung up on immediately.

she called again complaining about stomach pain then she pitched the idea to the physician during the consultation! she agreed to meet after the appointment, later at a cafe

finding people to give business or subject matter advice, you have to network it doesn't need to be painful it can be through 1x1 discussions but the problem is at start, your network might be zero you always have yourself - talk to anyone that will listen

for example a recruiter called her for a role, she talked to her! when she was looking for a business advisor, she thought back to her high school friend's dad. it didn't go anywhere BUT the mom took interest. she introduces someone doing clinical trials in India!

PLEASE unlock the power of serendipity about anyone that same friend's mom introduced her to her first optical engineer hire! Put yourself out there!

after you have collected your advisors, validated the concept, done all your homework it's time to raise money

for her, she had her concept, some physicians (12) that said it was a good idea but no money to build, no savings she kept getting 'no' from investors her initial $350k took way more than 50 no's - she stopped counting

but one woman was interested, talked to her for 6 months finally she was invited to meet in Boston no traction, but finally got an invite to meet her partnership it only takes one yes - and this was her last shot from her network

she knew that was her best pitch, they were so engaged after the pitch, Darshna said she'll call tomorrow with good news Surbhi flew home, kept her phone on loud it was a No.

she was devastated she asked why not - they said she had no experience running a company, no prototype... too risky she climbed into bed and took a pause that no had felt like a yes - so she thought of ways to de-risk

she called darshna back, said she will take more risk: she'll move back home with her parents, no salary for 2 years or until they raise money they said yes for 125k if she could find another person to take the other half she had someone waiting and she got it done!

remember it only takes one yes don't get discouraged validate your idea before, it will give you more confidence to handle the No's

investors are not validation for your product customers are validating your product

another thing about talking to investors: you should have such a solid understanding of your material that you can also read the room simultaneously reciting your numbers and picking up on cues that customize the pitch to the person you're talking to

for example - she saw interesting reactions when she used the word 'vagina' she switched to 'trans vaginal' and that went down better

never read from a slide, it needs to be authentic

on hiring, she had some money, a concept, clinical advisor. she had to hire again, she was a junior engineer at a startup, who could she recruit? then she remembered her boss at that startup Dave Snow, who liked her

her first hire was her former boss!! her VP of R&D joined her after doing some consulting work with her

always think about what you're doing now, how hard you worked, as the foundation for what you end up building later people will remember

always think through milestones first then hire based on those ideally for the next 2 years - hire the right people to achieve those goals make sure you know what each hire will be doing for 8 hours a day

here's the headline - seems easy

but this is the reality: it was a long and tough journey including very tough process with the FDA

she never became a founder for the sake of becoming a founder she did it to solve the very real problem that she experienced she couldn't think of another job that would be as impactful as an entrepreneur then she met @snowmaker and the biotech fund at @ycombinator

they wanted someone to come in and manage their biotech investments her favorite mantra: build something people want in healthcare, sometimes it's building what people WANT and sometimes it's what people NEED

@snowmaker plugged Surbhi's new book, which goes into more detail about her story: https://www.amazon.com/Without-Doubt-How-Underrated-Unbeatable/dp/1982147903

her advice on dealing with the FDA 1/ start with the FDA website, they put a lot of information about processes there 2/ search the FDA database for previous approvals 3/ every approval will be linked to the name of the person who filed, find them on LinkedIn and hire them