Surbhi Sarna founded nVision Medical to develop ovarian cancer detection devices, sold her startup to Boston Scientific in 2018 for $275 million, and is currently a healthcare partner at YC. In Without a Doubt, she writes about her founder journey, from the teenage health scare that motivated her to work in women’s health, to raising her series B while having a baby. I enjoyed the book’s candor and tactical advice, especially the tips on hiring, raising multiple rounds, and selling a company.
My main takeaway from this book is to dig within for what you love and listen to what you feel. The book also talks about coping with imposter syndrome — not only should I overcome my feelings of self-doubt, but I should also recognize how personal insecurities can create blind spots and lead to poor decisions.
#1: Be honest about what you want to do.
I realized that the single most important decision I made in my career was to push forward even while being doubted by so many because I’ve learned that for me, I’m more likely to be successful when my work is attached to a wholly felt passion.
Don’t apply to companies and positions you are not interested in. If you just listened to yourself, you will have so much drive. Find your driving force: “If not this, then what else?” You have to be happy with what you are doing. If you do work you really care about, the drive will come naturally.
Also, before taking on an opportunity, always ask, “Is this getting me closer to where I want to be?” Surbhi said no to a position at Abbott because it would take her further away from her ultimate goal of getting R&D experience and starting a company: being a manager in the quality department would not provide the technical tools she needed to start her own company. You must keep your ultimate dreams in my mind, and sometimes that means making short-term sacrifices for long-term gains.
#2: Coping with imposter syndrome
Do your best to push past feelings of imposter syndrome and make the most of the opportunities you have. Remind yourself why you are drawn to the work and the risks you are willing to take to get there. Proactively fight off insecurity and focus on your strengths
Even when you do face bias, try not to expend too much mental energy sorting through whether biases exist in whatever current situation you are in. I found this advice helpful:
“While it’s fine to acknowledge that it might be a possibility, you should try to recognize as quickly as possible that there’s also a chance it may not exist. You can’t let negative assumptions or realities affect your ability to do your best. Focus on the task at hand. Don’t worry about what other people might be thinking, because you really do not know. Assuming everyone is against you is a recipe for failure.”
Don’t let others’ doubt sway your decisions (especially lead you to decisions that create short-term gains but ultimately undermine your goals), make you doubt yourself, or jeopardize your health.
#3: Operating and fundraising advice
This book is chock full of excellent operating and fundraising advice. I’ve categorized them here.
Fundraising
Use your affinity bias to your advantage, or at the very least, pitch the people who understand your problem.
“After being repeatedly ditched by men, it dawned on me that most of my early supporters were women. Perhaps they better related to the problem I was trying to solve, or perhaps they could relate to me better. Most of them had achieved amazing feats in their careers, but few if any had been bestowed with the brand name that many of their male counterparts had despite their similar accomplishments.”
Don’t fundraise with an advisor. You must show that you are able to stand on your own two feet. Founders should feel confident in fundraising by themselves, and only bring other team members if they are requested by the investor.
How to structure your healthcare pitch:
Motivation for starting the company (the cancer scare that happened so long ago)
Clinical need: how much we could help patients with this product
Market size: how many patients in the US alone there are
Regulatory and reimbursement pathway
Competitive landscape
When pitching or describing a topic, it’s easy to rattle off facts about the marketplace opportunity or the exact approach you’ll take when creating your patent portfolio. But remember that investors, potential advisors, and employees are all people, and people are easily bored. Instead of simply bullet-pointing your ideas, engage your audience with a story that helps them understand what you’re trying to achieve relevant to their interests. It is possible to find interesting transitions between even the most seemingly mundane facts, weaving them into a compelling narrative.
Why are you excited about the opportunity?
Can you figure out a way to make them feel this excitement?
Rinse and repeat
Seeking something elusive like funding for a startup or a high-level leadership position in any industry will generally have a similar pattern: tell a good story, get rejected, tell a good story, get rejected. And on it goes until your story finally resonates with someone.
Make your descriptions more vivid and easier to understand.
I could say that the fallopian tube is hard to navigate because of its thin wall thickness and tortuosity. Or I could say that it behaves like a light, wet paper towel. The first description sounds more scientific, but the second is easier for the audience to visualize and understand.
Tell a story and make a business case. [Tim Draper] encouraged me to open the pitch with my experiences as a young woman navigating my disease and the medical community and then hit the audience with the facts. He felt strongly that you could do good and make money, that these things are not mutually exclusive.
Startup founders know that they’re pitching when they raise capital, or when they present in front of executive teams, but they often don’t realize they always have to be pitching.
I allowed the investors to control the meeting, a big no-no, going into the weeds of their questions instead of redirecting them to the most important parts of my message.
Hiring
Hiring the right team is one of the topics I get asked about most from new founders and new managers. Rightfully so, since it’s the most make-or-break aspect of any project. How do you go about making sure that you’re hiring the person with the appropriate technical or operational background? Who also has the right mind-set and attitude? Finding the balance of experience and values is not an easy task. Furthermore, how do you make sure that the people you bring on will mesh with and enhance the culture you want to craft?
To me, the first step is not to think about who you know, but what you need. In other words, think through the milestones you are driving toward. Then, think about the type of people you want in your corner to accomplish those specific goals. What kind of experience and skills do you want these people to have? Once you start creating these ideal profiles, it’s easier to understand the kinds of people who might be a good fit
To do this, I would need engineers with a variety of skill sets: someone who could come up with the high-level concept/innovation; someone who could translate that into an early-stage prototype and also navigate the regulatory requirements of creating the necessary supporting documentation; and a technician who could enhance the design and build several iterations of the devices for testing.
This coup goes back to clearly articulating your vision and demonstrating that you have the drive and focus to achieve your goals. Attracting A-grade talent like Dave and Wendy had a positive, amplifying effect.
Ultimately, no matter how careful you are when interviewing candidates, you are going to make mistakes. What’s important is letting them go quickly before too much damage is done, before they bottleneck other team members’ work or poison your culture.
The key question in figuring out a compensation package is “How important is this person to the success of the company and, thus, what should I do to retain them?”
Managing a team
Overall, the more that you ask about your coworkers’ lives and the more you’re willing to share yours (when appropriate), the more of a human connection you form. Nothing persists through time and memory like human connection.
If someone is performing well in their key areas, allowing them to expand their skill set is a great way to keep them challenged and satisfied. This is especially important for startups that statistically have such a low chance of success.
Preparing for meetings
Always research someone before meeting them. Find out what type of things they are most interested in professionally and how their particular experiences are a good fit for what you are trying to do. This creates a more informed and efficient discussion. “People are more inclined to roll up their sleeves and spend time with you if they know that time won’t be wasted and will amount to something they care about.”
I was surprised at how much detail he knew—not just about what we did at the company, but also the potential risks as we moved forward. He also listened to what I was most worried about.
Even before we started working together, I knew they were sharp because of the questions they asked during the diligence phase, which lasted almost a year from the first meeting to the deal closing.
Quotes I liked
“Business skills can be acquired while you’re building your company. But mastering the technical skills needed to execute the business you want to be in—whether that’s retail, art, health care, organic farming, or green energy—begins with an understanding of that field from a technical perspective.”
“I made sure I finished all of my main assignments on time, and then would switch to other tasks, taking on small projects and collaborating with people in different departments.”
“Anula didn’t have enough ego to believe that only her advice would be sufficient to create a successful company, so she helped expand my advisor network.” - it takes one true believer
“The next time you’re going to be late, don’t show up at all.” (Tim Draper)
“Cami listened and then asked why she wanted to be an entrepreneur, to which the woman replied, ‘Power.’ Cami gently explained that power wasn’t the right reason to be an entrepreneur. I joined the conversation and gave the same advice that I give anyone who asks me about starting a business or innovation: the only reason that someone should become an entrepreneur is that you deeply believe in the potential impact of what you’re creating.” (I think this is what stuck with me the most from this book.)
“The people at Arboretum were friendly and smart, and asked astute questions about pricing and how the product would be used. Their questions and recommendations even led us to revise some of our clinical trial plans. I was excited to have them as an investor and thought they would make a great addition to the board.”