Y Combinator
Reshma Khilnani
Founder of MedXT (YC W13)


MedXT is a medical imaging storage and management service. We manage images like X-rays, CT scans and pathology slides online. (MedXT was acquired by Box in October 2014.)

Q: Where did you work prior to starting your startup?

I was on the product team at Facebook and Microsoft (where I met my cofounder) before starting MedXT.

Q: Tell us about your experience at YC.

I left Facebook in December 2012 to join YC in January 2013, and I was completely unprepared for what was going to happen. Somehow, I thought that YC was going to be like the partners critiquing your product, giving you pointers on how to make your app have a cooler design or technical guidance on databases, etc. I was completely and totally wrong.

YC is gently pushing you off a cliff and seeing if you can fly.

In my case, I was planning to spend all of YC (Jan-March 2013) developing our technology. But it was immediately clear in our first meeting with YC partners that it was expected I should sell the (then nascent) product at least once before Demo Day. I was incredulous. I thought, "This product needs regulatory clearance and physician approval to sell! There is no way I can sell it in less than 3 months!"

Their answer: "Figure it out." That's the moment when they were pushing me off a cliff and watching what would happen.

In retrospect they were totally right. We found a buyer who was going to use our product for backup and therefore didn't need the regulatory clearance. Now that we've received our clearance, that same initial customer is an enterprise customer with a substantial annual contract. It was a big break for our company.

Q: What is the atmosphere like at YC as Demo Day approaches?

Demo Day is a big milestone for all YC companies and, as it gets closer, the teams in the batch start to grow more focused and intense.

Your YC batchmates start to look and behave increasingly like zombies– everyone is trying to grow their revenue, close key deals, launch products, etc. When you go through this intense period together, it's a real bonding experience.

Q: Was being female either an advantage or disadvantage in working on your startup?


The biggest advantage is that being female makes you memorable. I'm a woman, I'm in enterprise software, I'm a CTO, and I'm very tall. This causes so much cognitive dissonance in people's mind that I can pretty much count on them to remember me. This is a plus in many settings– recruiting, customer development, fund raising, etc.

There are disadvantages. There are some people (men and women) who won't work for a woman, so I can't hire those people. There are some people who use pattern matching to make investment or partnership decisions etc., and I was born outside their mold.

I think it is important not to be thin-skinned as an entrepreneur. If I obsessed about press articles referring to me as "he" or being mistaken for an assistant I would go crazy. The point is to build a business. I'm saving my energy for that.

Q: Why do you think there are fewer startups with female founders than male ones?

I can only comment based on my experience and observations but I think there are 2 major contributors to the fewer female founders phenomenon:

  1. Few role models

  2. Less safety net

Role Models: I don't like using money as a barometer for everything, but it is an objective criterion so I'll use the "Top 10 Richest in Tech" lists as an illustration.

Richest (all men) - Bill Gates (founder), Larry Ellison (founder), Larry Page (founder), Jeff Bezos (founder), Sergey Brin (founder), Mark Zuckerberg (founder), Steve Ballmer (early MSFT), Michael Dell (founder), Paul Allen (founder), Azim Premji (son of founder)

Richest women - Lucy Peng (CPO Alibaba), Angela Ahrendts (SVP Retail Apple), Amy Hood (CFO Microsoft), Renee James (President Intel), Susan Wojcicki (CEO Youtube), Ursula Burns (CEO Xerox), Safra Catz (CFO Oracle), Virginia Rommety (CEO IBM), Marissa Mayer (CEO Yahoo), Sheryl Sandberg (COO Facebook), Meg Whitman (CEO HP)

While the men are largely founders, the women are executives or early employees at large companies. I don't think you can fault a woman for coming to the following conclusion: to be like these awesome women who we admire I should (a) grind my way up the corporate ladder or (b) get on a rocket ship and do a great job. Neither of those options are being a founder.

Many in the startup community idolize founders. But, to those outside our community, being a founder isn't obvious. Having spent years in corporate life and seen the other side, this perspective rings true to me.

Less Safety Net: We're very lucky as technical people to have a lot of options in today's job market. One of the phenomena that has encouraged entrepreneurship is that, for the average YC founder, doing a startup just isn't extremely risky. If things go well, you have a successful and valuable company. Great! If things go poorly, you get acquihired by one of the bigger tech companies or you sell your technology assets. If you net out the years you spent on your business and the compensation you get with your new position, the average YC founder probably makes as much money as having a job for a couple years. Tech professionals are well-compensated, so the worst case isn't bad.

I think this safety net is less available to women. Based off the people I know, few of these aquihire opportunities seem to go to women. I won't speculate on why this is the case, but it does have a macro effect. If you have less opportunity for a soft landing, you are taking a greater risk. Finding people willing and able to take such risk will be harder.

Q: What was the toughest thing you went through as a founder?

Founders go through a lot more rejection than other people. Shortly after Demo Day, there was one day when a potential customer told me I was crazy to think that a diagnostic imaging pipeline could be run on commodity hardware in a web browser and that it was impossible that a service like that would ever be good enough. On the same day, a potential investor said he wasn't interested because the idea was "too incremental".

I was very frustrated. I started to think I was losing my mind. How can a product be both impossibly big and too incremental? What I realize now is that every entrepreneur– even the ones who are now successful– has experiences like this. Being persistent and making things happen anyway is so important.

Q: What do you wish someone had told you when you were 15?

I wish someone had told me to be less intimidated by computer science. I did well in math and science as a 15-year-old. However, when it came to programming and CS– even as a 15-year-old– I started to feel like I was already eclipsed by my peers who had programmed games. This amplifies over time when you see some programming wunderkind on the cover of Wired or TIME. I got the feeling that I was so behind it didn't make sense for me to pursue this field and I almost opted out.

I think about it differently now. Computer science and programming should be thought of as a fundamental like reading or math. I'd tell a 15-year-old to think of them that way. Study computer science and get good at it just like other subjects. Don't opt out of computer science because you think you are behind. You probably aren't.

These days more and more people are encouraging women in tech, and I think that's wonderful! But with all the excitement, sometimes I think it is hard to keep an eye on the big picture. The point is not to create an army of women programmers (though there's nothing wrong with that) but that women should have the same chances for leadership as others. Leaders of the future will need technical skills, hence the emphasis on coding. We need to make sure that we give the same encouragement and support to female leaders in politics, media, in executive roles in companies, founders and more. Every example helps shape peoples' minds and creates opportunities.