A conversation with Jen Avari Silva, Cofounder and CMO of Sentiar and Associate Professor of pediatric electrophysiology in the Department of Pediatrics in Cardiology at Washington University in St. Louis.
Jennifer Avari Silva, Cofounder and CMO of Sentiar. Professor Avari Silva is a pediatric electrophysiologist in the Department of Pediatrics in Cardiology at Washington University. Her research interest is in arrhythmias (and transcatheter ablation), digital health and emerging technologies, cardiac ion channelopathies, and implanted devices such as cardiac resynchronization therapy. Professor Avari Silva cofounded Sentiar in 2017.
Please tell us your background story on how you ended up starting Sentiar.
Jennifer: I am a pediatric electrophysiologist taking care of kids with heart abnormalities. I work two days in the lab, performing procedures, one day in the clinic seeing outpatients, one day at Sentiar. In between all that I help manage outpatients by reading EKGs and cardiac monitors for patients across multiple hospitals and systems through a few states in the Midwest. As a fellow, I was interested in emerging technologies and how they could be applied to my patients. It intrigued me that nobody was trying to take innovative technologies and apply them to kids, instead they wanted to apply them to adults, to the 80-year-old patients. I engaged with smaller startups and worked with them to apply their technologies to this unique population. The difference was that I was not afraid of the FDA or IRB and my patients are really pretty amazing! They want to try these technologies not only for themselves and their own kids, but they really are altruistic and want to help future kids who may need these technologies. What an amazing gift!
In 2015, I had an idea to create a new technology with my husband, Jon Silva, who is an engineer also at Washington University in Biomedical Engineering. When we started, we had no intention to start a company, just an innovative idea that we thought could add value to physicians and patients. I pressure tested the concept with my clinical partners and others by asking if they would use it or buy it—they all universally thought it would be an incredibly value add, but didn’t think that it could be done. This was market research, but we didn’t call it that at the time. As we worked through exactly what our Version 1 would be, he built me a prototype for Christmas in 2015. The minute we first tried the system on, we knew we were about to embark on something profoundly important. We were unsure, but once we saw the prototype, all uncertainty was gone.
We went to the Office of Technology Management (OTM) with the design, specs, and prototype, and they quickly turned it into a provisional patent. I really need to say, I was so uneducated on the process of patent writing, disclosures—it was a new language, and I was grateful to the team here at Washington University that helped me but even more importantly, educated me as we went. I was fortunate to have lots of friends in industry trying to tell me what to do without actually telling me what to do. I needed to make mistakes along the way, and then talk to them when I had done this step, and repeat. We knew were sitting on an idea with a lot of industry interest and needed to start a company or let OTM decide to license it.
Our kids were young at that time—2 and 5 years old. But at the same time, we were worried if we didn’t do it ourselves, that it would not get done right. We had this very clear vision that became more refined over time - what the tool is, what it could be, and what it needs to be to add value to help patients. If the technology was licensed to industry, we knew that we would have no control over the iterative development and that they would do what they wanted with it. But being a clinician at heart, I felt strongly that we knew what needed to happen and to keep the clinical need at the center of the development. So, we founded Sentiar. We didn’t know the time commitment and travel involved. I don’t think we would have done anything differently had we known more, but maybe we would have been more prepared. I feel strongly that when other companies or investors tell us how we need to develop our tool, we center back on the question is it adding clinical value? And if the answer is no, then we won’t do it. My guiding principle is that it must lead to a better outcome for patients.
Were there specific scientific or career milestones, such as tenure, that you achieved that made you believe that now was the time for you to pursue entrepreneurship?
Jennifer: I came off my tenure track when I was pregnant with my first child as I knew at that time I was not going to meet the strict policy at WashU. I asked a couple female electrophysiologists how you balance having kids and an academic clinical career, and while everyone had slightly different feedback, there were a few themes. One was that it was too hard to do it and remain on a tenure track. You do not have a time bound on the non-tenure track; and this disproportionately affects women. So I came off the tenure track, had children, and then moved up to Associate Professor.
I will say that I did not do a good job of promoting myself or my accomplishments during that time. I was promoted from assistant to associate professor with no meaningful salary change. Interestingly, I got some really great advice from the Chair of Biomedical Engineering here at WashU—she told me that she needed me to tell her when things were going well and when they were going poorly. We assume that people are paying attention to what we are doing, but everyone is busy and can’t keep up. She suggested I drop her an email of what I am proud of that reflects well on the University and Sentiar. That stayed with me for a long time.
I was later interviewed by BBC, a science podcast story on Sentiar, which was a super exciting bucket list item for me. Jon was the first person to say, are you going tell anyone? I debated sending the Chair an email and thought no way! But I thought about the good advice I had been given earlier, and I finally sent the interview to the chairman and my division chief. I was so glad I sent it to them, as they wouldn’t have seen it otherwise.
What are the biggest differences between your role in academia and your role as an entrepreneur?
Jennifer: The ability to organize people and triage translated well from academia to entrepreneur. Sentiar made me a better leader which translated back into the clinic. I believe strongly that being involved in startups has made me a better physician and that I can understand all the pieces on a deeper level than you ever had before. The amount of knowledge I have acquired over the past five years I could not have gotten any other way. People should not be afraid of conflicts of interest; women seem to worry about this much more than men.
Do you have entrepreneurial mentors or sponsors? How did the relationship start, and what has it brought to you?
Jennifer: None are female. I have someone who is my go-to serial entrepreneur, an Italian gentleman who now lives in Geneva. When I have questions, I hop on a plane and go to Switzerland to see him. We met through a mutual friend whose company acquired his third company.
On our first meeting, I wanted to show a demo, and he said no, we are not looking at your tech. Put all that away, and let’s have a conversation. He told me afterwards that he didn’t know if he had time for me. I said he needed to make time for me; I didn’t have anyone else. He appreciated my persistence. We meet in person at least a couple times a year. He’s also met my husband and kids, company aside. Each conversation he would always start with how are you, take a breath, what’s going on in your life, not at Sentiar.
Although he is an investor by profession, I would not ask him for an investment. It shifts the dynamic. You need one safe haven. He’s my one. You also have people who help and teach about IP and how to negotiate. You will always find people like that along the way. Someone who has walked in your shoes makes a huge difference.
How do you achieve work-life balance to pursue entrepreneurship? How has the current COVID crisis affected this balance?
Jennifer: Our kids are now 9 and 7, and we didn’t realize with both mom and dad as cofounders how hard it would be on the kids. We had to do a lot of balancing, and they often got caught in the middle of it. We realized that by 2016, it was not sustainable. We couldn’t do it--homework, clinical work, and run a company. So, I asked my mother-in-law for help, and she moved in with us. Parenting for us wasn’t a 2:2 ratio, we needed a 3:2 ratio. We couldn’t have done it without changing that ratio. Having my mother-in-law helped change our household conversations from always talking about Sentiar to a well-balanced discussion about school, friends, work, travel, etc. We became more normal and found balance allowing us to do things like work travel. We didn’t anticipate work travel, and it’s a lot when you are involved in a startup. There are not very many vacations. However, travel stopped with COVID, and that re-shifted our dynamic. Our family has become very used to having everyone at home. At some point, that will change again, and it will be an adjustment. But they are resilient. And I think that they are learning by watching — I think it is so important for them to see us achieve these amazing things and know that there is no limit on what they can achieve in the future.
When COVID came, Sentiar was in the middle of a Series A round fundraise, and our two kids were about to be homeschooled. I couldn’t take on any more roles; I was out of hours. To make this work, you need to have a good team in place—for us, at the clinic, at home, and at our company. I needed flexibility to make it through to survive. For example, I had an investor call in Europe and could only make the call in the cath lab while wearing my PPE. They must have wondered “what is she doing?” But I couldn’t make another time - they called the meeting, and this was as present as I could be. And I didn’t apologize for it. This is me giving my all.
What was your experience in fundraising? Do you consider it any different than that of your male colleagues?
Jennifer: There is a huge difference fundraising as a woman. I will not pitch alone. It’s destined to be unsuccessful. I learned early on, even without a CEO in place, when Jon and I would pitch, everyone would sit down and look at him and start talking to him about the company. And then eventually, when we would get to the clinical gap, solution, etc., he would say, you need to talk to her. It was always uncomfortable. Some of those people invested; most didn’t. Our current CEO has done an amazing job. He practices pitching a lot and has gotten very good at doing it—we are really proud of him! He recognizes at the end of the day that I bring the authenticity of the clinical perspective, and that Jon brings the same from a technical/engineering perspective. When pitching to investors, I answer the questions on the clinical applications. We actually usually split our pitches where I always have a male lead and set the table, then I talk about the problem, solution and data, and then turn it back for the business model and commercialization plan. When Jon is with us, he takes over on IP, strategy/grant, and technological development timeframe.
During these discussions, I find that questions are phrased in the negative to me, to Jon in the positive. I hope it changes, but it will take several successful female CEOs to get there. Part of that is we as females need to go out and fundraise, even though there is not equity in it.
I have mostly pitched to males and some females. I actually find some female investors are harder to pitch to; we hold each other to a much higher standard than male colleagues. I can count on one hand the number of females I have pitched to in over 100 investment groups pitched.
What do you think deters women from pursuing entrepreneurship?
Jennifer: Women worry about conflicts. Family life can be an interesting consideration. I do what I do because I married my best friend who thinks I can do anything, and we are a team. That means that we make sure that we have the time we need to get things done. Sometimes, that means that I need to leave work early for him to get something done. And the same holds true in the inverse—there are so many nights when I need to work later, and he just takes the kids and orders dinner to the house and gets it done.
I think that faculty entrepreneurs are bad at promoting ourselves because we perceive entrepreneurship as a conflict. The University feeds this by not necessarily valuing entrepreneurship. There are no bonus points for starting a company, although maybe a bonus for developing intellectual property.
What was the best advice that you received? And to counter that, did you receive any advice that you would not pass along to another aspiring female academic entrepreneur?
Jennifer: The worst advice came during a financing round. I was told we needed to accept the terms, and all would be ok at the end of the day. This was early on, and I was not savvy enough to ask about a waterfall model, how it looks in the future, and its impacts. There’s a notion as an academic founder you should be quiet and let the business people take care of the financing. So, I did not ask questions around equity and financing. Now I ask all kinds of questions. We think everyone else knows the answer, and they don’t. It ended up being a good lesson from bad advice. It was a painful lesson and every time I look at the cap table, I see that.
What haven’t we asked you about that you think is important for women academics to know when delving into being involved in a startup company?
Jennifer: Academics who do startups are a small group, and the subset of females from that group is vastly smaller. The data are important and we need to be honest with ourselves about it. You need to know that funding is not being dispersed equitably and then make your decision forwardly. It is important to not sugar coat the process—it is not always rainbows and unicorns. If you have a male cofounder, excellent, keep him and use him to your advantage. There are a lot of husband/wife founder teams, and it works for us, though many investors won’t invest in a married couple. You can rage against that, or say they are not the right investors for you. It is a luxury to say that, and a great investor understands why your founding team is valuable.
We need a way to organize women entrepreneurs in academia and provide a sense of camaraderie.