23andme is a great medical startup, but it is a capital-intensive business that has to spend time and money on Washington.

We (Epocrates) are working on an Electronic Health Record system as an additional product. Our core team is small, but we have the resources and brand of a midsize company. We have 40% of US physicians using our existing reference software and we are going to leverage our brand to provide a usable and moden system that increases the level of patient care and effectiveness of Doctors. We're a mixed RoR/Java/Mobile shop. We're currently hiring RoR developers, so please feel free to contact me if you are interested in this space and want to make a real impact on US healthcare.

The medical device/software field is certainly interesting, exciting even at times, but it progresses at an absolutely glacial pace for the most part. You're dealing with slow, conservative institutions (hospitals, etc) and government agencies. Unless you hire people specifically to deal with those soul-crushing interactions, you'll probably want to shoot yourself.

Part of it may be that you need medical connections to do the much of the work. We work directly with a ton of different doctors/hospitals (for a team of only ~15 devs), and still have issues with building the right things, 510k submissions, etc...

But yeah, medical applications are getting neglected by the startup community at the moment.

Many developing countries have had none or next to nothing health insurance till recently. But the market penetration of the healthy insurance is increasing (but still very low now). Because of that more people who could not afford advanced diagnosis or treatments earlier are able to afford them now.

Imagine the potential size of the industry when 1 billion people in India and 1.4 people in China (not to mention a billion or more in other developing countries) can afford as good health care as the 300 million in US, the 450 million in Europe, etc

I am curious as to what you have in mind. (I tried to find an email address for you and couldn't. Sorry to junk up this thread. You can email me -- from one of the websites in my profile -- if you don't want to post it here.)

The way a lot of record labels work is that they will give a band a cash advance. The band uses that advance to pay for living expenses. They are also forced to use it for various costs such as studio time, recording, producing a music video, etc. The band earns a percentage of the gross revenue for album sales (say 7%), the label earns a larger percentage. The band pays back their advance using their share of the earnings. Stop me if it seems like there's something a bit off about this arrangement.

Sending a fledgling startup company to work amidst that hell is not a smart move. Even billionaire multi-platinum bands have trouble.

One question though, what about startups from outside the US? Can you offer advice there visa-wise and such? I know it doesn't really matter for the three month period, but what about after that. It would really suck for a startup to do well on Demo Day, only to be unable to go to any meetings because they can't get back to the US for a few months (I think the wait period is another three months)

Once you raise enough to pay yourself market salary, the situation transitions from "impossible" to "annoying and long".

So focus on the product, then on funding and/or revenue: the rest will follow.

If you mean do a program like YC, it's fine. The reason it works in this situation is because you aren't making any money. The INS does not care if you are "working" if you aren't actually making any taxable income.

If you mean draw a regular salary, it's harder to do that legally but I have a friend in France who runs a 1-man consulting firm that does short term contracts in the USA and he's figured it out. I don't think it was easy in terms of "no work" but it was just filling out a bunch of paperwork.

Doing the job you normally do isn't allowed, but it seems like it's pretty obvious that people do that.

It is possible to bootstrap a company in such a way as to plateau out at, say, 3 people, each of whom gets a decent market salary. However, that company may not have further room to climb for various structural and/or marketing reasons, lack of appropriate connections, funding opportunities, etc. In principle, the purpose of YC is to address that specific gap irrespectively of how much short-term revenue the startup may be generating.

On the other hand, I agree that the amount of funding they provide per se is not particularly useful if you are already generating enough revenue to pay yourself(ves) a market salary.

As pbiggar points out above, there's no problem (at least for EU citizens) getting into the US for three months of YC - it's staying there long term that's hard.

Has anyone here on HN got into YC from London?