Women and people of color who have experienced any sort of health issue know that our standard of care is somewhat abysmal.

“We don’t deserve a second-class medical system just because we were seen as second-class citizens for such a long time,” said Surbhi Sarna, Y Combinator partner and author of Without a Doubt: How to Go From Underrated to Unbeatable.

“I wanted other people to understand the importance of women's health,” Sarna told moderator Rosalie Chan, senior tech editor of Insider, in a fireside chat at From Day One’s 2023 Silicon Valley conference. Sarna said the experience of turning her health scare into a success inspired her “to change the state of women's health care.”

The Journal of the American Heart Association concluded in 2022 that women were less likely to be admitted when presenting chest pain in the emergency department. The study also confirmed that women and people of color waited longer to be seen by physicians.

Sarna had an ovarian cancer scare in high school and suffered from debilitating pain. It took months for medical professionals to tell her she had a complex ovarian cyst. Grappling with invasive blood tests and ambiguous ultrasounds, she was left with the options of surgery, the possible side effects of a biopsy, or allowing the mass to dissolve independently.

Ultimately learning it was not cancer, Sarna wanted to make a change in the world of women's health and began working on raising capital to create a first-in-kind microcatheter for the detection of ovarian cancer.

“And so the idea was born,” she said. “But women's health in 2010 was the least sexy area for raising venture capital. So, talk about being doubted! I always had to go in front of a room of men and say the word vagina because it's part of women's health.”

Sarna says that responses to this clinical term were perplexing, with men leaning either in or out. In addition, the fundraising process was nightmarish, with people telling her that women’s health was “bikini medicine.” Nevertheless, she proceeded.

“It took me a year to raise $250,000 to build a prototype,” she said. “Doubters even said the market size was too small. Yeah, women only make 50 percent of the population – tiny market size.”

Additionally, it was difficult to attract male engineers to the project of creating a women’s health device with a young female chief executive officer at the helm.

“Eventually, I did find a team who believed in it,” Sarna said.

She recalls that the strategy of putting fear into her donors' hearts finally worked.

“If they didn’t invest in me, they would miss out,” she said. “I told them nobody else understood this disease state as well as I did and that I could write a textbook on it. Of course, the first several checks written were all from women, but women who believed in it.”

Sarna’s doubters only motivated her more, driving her to raise $20M in venture funding and to complete three clinical trials with two first-in-class FDA approvals. The result: nVision Medical, which developed the first microcatheter for the identification of ovarian cancer. 

In 2018, Sarna sold the corporation to Boston Scientific for $275M, more than 15 times the money invested and one of the most significant exits in women’s health. She stayed on for the following two years, running the organization in preparation for its inception. 

“It was a very proud moment for all of us,” she said. “But I realized I wanted more people to understand the importance of women's health, and I wanted more examples of women leaders out there reaching for their dreams.”

As a woman of color raising capital in tech and medicine, Sarna is candid about her experience of navigating structural biases and her struggle with self-doubt in her book.

“I wanted to be honest about the challenges, what it was like to fundraise as a woman, and then to be pregnant, and then have a one-year-old at home at the time of the exit,” she said. 

Sarna says the unconscious bias and sexism she experienced in raising capital fortified her and fueled her courage to speak up for other women. 

“Before, I might not have felt comfortable to call it out,” she said. “And now if I’m in a roomful of men, and they're talking over another woman, I just say, ‘Sorry, Bob, I think Sally was speaking.’”

Currently, as a partner with Y Combinator, where she invests in early-stage companies or startups, Sarna says changing corporate values are at the forefront of their work. 

“Leaders of companies are revisiting their values and having open discussions about them,” Sarna remarked. “All of us know that culture happens one way or another, by accident or by design.”

Sarna says that, in times of turbulence, employees return to cultural values, which are a company's glue. 

“Values are the light at the end of the tunnel,” she explained. “ They keep you going and remind everybody why they are there in the first place, why the companies work matters, and why they matter.”

As someone who built her ladder to her success, Sarna says that having strong values to return to while raising money for capital was necessary. 

“I can't tell you how many times I talked about this in the book,” she said.

In light of news about Theranos risking patients’ health by misrepresenting the accuracy of blood analysis technology and defrauding investors, Chan asked Sarna how she assesses due diligence as a partner. 

“What I’ve come to realize after working with the hundreds of founders is that the vast majority just aren't like that,” Sarna said. “Most of us have gotten into health care because we hope to make a difference to patients.”

Sarna does intrinsic motivation sessions with her founders at Y Combinator. The sessions are based on the neuroscience of our spontaneous tendency to be curious, seek out challenges, and gain knowledge without rewards. These gifts will keep you going in the face of obstacles and doubt.

“When everything is falling apart, your data doesn't come out the way you want, or your current investors aren't willing to write you another check,” she said. “What keeps you going? What is that intrinsic motivation?”

Sarna says the latest session with her team was very emotional because many members were personally impacted by issues related to health care in one way or another. 

“They fundamentally want to create positive change in the ecosystem,” she said. “So, I'm not blind to what has gone on around us; I remain very optimistic about the mentality of most founders, especially in the health care and life sciences space.” 

Chan asked Sarna, a founder in biotech without a medical background, how she assembled the right team. Although Sarna graduated from the University of California, Berkeley, where she studied molecular and cellular biology and bioengineering, she does not have a medical degree. 

Sarna says she started with her previous boss, David Snow. The initial meeting was uncomfortable, but Sarna suggested he consult with her and try it out. After a couple of months, the partnership was sealed and the company was off to a good start. 

“I think you need to remember that the reputation you build is so important, especially right now, on top of all these layoffs,” Sarna said. 

With a strong partnership and an established team, Sarna and her colleagues were methodical about their cultural values. For example, employees needed to enjoy working, not just show up for a paycheck, and to have a good sense of humor. 

“We wanted people who would take the work seriously; don’t take yourself as seriously,” Sarna said.

From that point, Sarna says the team had a good understanding of their cultural values, technical skills, and the operational skill sets the work required.

“The combination was just magical for us,” she said. “We had an extremely high retention rate after that, because when it fits, it fits.”

There were mistakes along the way, Sarna admits. 

“I once hired someone who kept calling the word vagina a ‘hoo-ha,’” she said. “They were the Head of Clinical, and needless to say, that hire did not work out.”

Still, Sarna says that these experiences helped everyone stay clear on their commitment to their values. 

“It cemented our values even more,” she said. “And whenever we tried to move outside our values, it didn't quite work for us.”

Chan asked Sarna how Y Combinator supports startups in developing healthy cultures. 

“Being a founder is an incredibly hard job; a lot rests on your shoulders,” Sarna said. “But one of the advantages is that you can be deliberate about the culture from day one, and it can be an extension of yourself.”

Sarna says that corporate values and culture are concepts you feel and live naturally, but that they need to be talked about and revised, so the company walks its talk. 

“If you have a cultural value of integrity, or you are holding yourself to high standards when it comes to handling data, it extends into how you make choices,” she said. 

Ending with the trending topic of layoffs in the tech industry, Chan asked Sarna how she thought this would impact the startup ecosystem. 

“It takes one door closing before you can even notice another one's open,” Sarna said. “And I think that a lot of the engineering talent that has been let go in the valley is thinking, ‘Maybe now it's time to pursue that dream I had of starting another company or bringing this innovation to life.’”

Y Combinator sees over 17,000 applications twice a year. “Right now is a great time to do a startup, because it takes seven to 10 years to build a good, solid company,” Sarna said. “Even though I can't crystal ball what the economic climate will be then, it may be better than now.”

Krista Sherer is a strategic communications consultant with a background in journalism and corporate communications. She resides in Sebastopol, Calif.