How to pivot your way to product/market fit & other 0-1 lessons — Rupa Health CEO Tara Viswanathan 

I think that almost every founder story is exactly like mine, where it's struggle for two years, hit on something that has product market fit, and then off the races. Most people, and I don't think this is because the founder wants it this way or anything like that, it's more of like a press story, all that. Most people chop off those first two years and pretend like it didn't exist. And there's nobody to blame for that. It's just a reality. We want to see the perfect story that is published somewhere. We want it to be really pristine and everything to make sense. But I think if you talk to most people, there are those two years of chaos before getting to the thing.

Welcome to In Depth, a new show that surfaces tactical advice, founders and startup leaders need to grow their teams, their companies and themselves. I'm Brett Berson, a partner at First Round. And we're a venture capital firm that helps startups like Notion, Roblox, Uber, and Square tackle company building firsts. Through over 400 interviews on the review, we've shared standout company building advice, the kind that comes from those willing to skip the talking points and go deeper into not just what to do, but how to do it.

With a new podcast, In Depth, you can listen into these deeper conversations every single week. Learn more and subscribe today at firstround.com. For today's episode of In Depth, I'm thrilled to be joined by Tara Viswanathan. Tara is the co-founder and CEO of Rupa Health, which helps create a simpler platform for doctors to order specialty lab work. Tara started Rupa Health in early 2018. But the product vision today looks very different from what she first built.

As she'll talk about over the course of today's interview, she went through plenty of sometimes painful pivots on the path to finding product market fit for Rupa. Tara is not going to tell you the overly sanitized version of Rupa's journey. And she's incredibly candid about all of the things she had to learn the hard way as a first time founder going from zero to one. For the first half of our interview, we pay particular attention to her lessons in finding the elusive startup Holy Grail of product market fit.

We cover the moment when Tara realized the first iteration of the product wasn't going to work, and why she thinks hiring a few folks before finding product market fit was one of her earliest mistakes. We then dive into her decision to create a new product knowing that it wasn't going to be the thing that ultimately worked, but was bullish that it would lead down the right path. Along the way, she unpacks her playbooks for assembling unofficial customer advisory boards with short feedback loops, which he believes was the key to eventually finding Rupa's wedge.

In the second half of our interview, she talks about hiring Rupa's early team and her tactics that go against the grain of conventional startup wisdom. For starters, she leaned heavily on external contractors rather than full time employees on the path to product market fit, and she thinks more founders should consider doing the same. She also dives into why she hates job descriptions and what she prescribes instead. As a founder still in the trenches, Tara is gained to get super tactical about the things she's tried along Rupa's winding journey that did and didn't work.

It's a must listen to for other founders or for anyone that's got a burning curiosity about what it's actually like to be an entrepreneur. After listening to the episode, be sure to check out Rupa Health's recent press coverage in Forbes, which announced the company's seed financing and outline its vision for the future of root cause medicine. We've linked the article in our show notes. I really hope you enjoyed this episode. Now on to my conversation with Tara. Thanks so much for joining. I'm excited for this conversation.

Yeah, I'm so excited. This is going to be fun.

So I thought the place that we could start, and it's one of the areas that I'm always most interested in, is the hunt for product market fit and idea generation iteration. And I think that Silicon Valley has done a good job of exporting how we scale companies. But I don't think there's a lot of writing and thinking and experiences around specifically zero to one. And so, I thought that might be an interesting place to start and learn more about the negative 6 months to first 6 months or 12 months of the company's life. Why don't we start with the original insight and then maybe talk about some of the iterations that got you to where you are today?

Sure. One reason a lot might not be written about it is because it's pretty unique to each company, and there's no rhyme or reason to it. But this is how we got started. I had a conviction about the market, the market being more holistic or integrative or root cause medicine, whatever you want to call it, this mix of wellness and medicine together. And I saw that this was happening probably since 2008, my freshman year of college, when I gained the freshman 20 and realize that there was more to life than just putting complete trash in my body.

And it started me down this path of just being interested in nutrition and everything that goes along with it. And that led me to this discovery of, oh, wow, the way that we think about health, wellness, medicine is changing. And I had conviction in that. I had no idea where the market was going, what kind of product would fit into it. But it was that. This is where I see the future, let's just start somewhere. And I had been a part of enough startups by then to know that finding product market fit is the Holy Grail. It's not just about what I want to see in the world.

It's not just about what might be nice to have. It's so many things. It's timing. It's finding the Trojan horse that'll let you expand into multiple other things. So when I started Rupa, I had that conviction in the market, I had no idea where to start. But I started with one problem, which is, how do you find doctors who will actually help you in a more holistic way? And so, we started out with a marketplace for functional and integrative doctors. And that's what we raised our pre-seed off of. And we went through two pretty big pivots to land to where we are today, which is a modern diagnostics platform. I can dive into any of those pieces, but that's the high level.

Yeah, I think it would be great to talk about the first version of the product. And I'd be interested in how you decided that it was time to go in a different direction. Because there's a lot of startup wisdom out there that's like you just have to grind and be relentless. But I think you've just done an amazing job of being curious and seeing where there's market pull, but I'd be interested in that first iteration of the marketplace. How did you know you just didn't have to work harder or tweak something and you needed to make a meaningful change?

Oh my gosh, you hit the nail in the head. I think that is the core internal struggle or dilemma for founders, because you hear these stories that are just like, well, this person was relentless and didn't give up, and that's why they push through and made it. Versus you hear other stories of know when it's time to quit and time to move on to something else. So I had a huge internal battle with that. The way that it happened for us was we had built our MVP.

It was just me and my co-founder at that point, and it was essentially a Zocdoc for acupuncturist, functional medicine doctors, people like that. And it was just in the Bay Area. And I mean, that is over glamorizing it. I think we had hand pulled a few 100 people, gotten all of their information ourselves, and created this prototype with an outsource dev firm for, I think, like $800. It was our own money. We had no money at that point. It was very, very rough. And from there, we were just doing whatever we could. I would send that to friends and see if it was helpful.

We started doing in person meet-ups called Rupa circles where we bring people together over discussions like acupuncture and things like that. We threw everything at the wall. And it probably took a year of us trying everything from concierge, one-on-one text conversations to help people find their doctor, to infiltrating Facebook groups, to just trying to spread word of mouth, and finding friends and friends of friends who were in need of a doctor. And we tried what seemed like everything.

And it all culminated for me on actually like the 4th of July, maybe two years ago, and I was sitting in our office alone at my wit's end. And someone had sent me Andrew Chen's 10 marketplace essays you must read if you're building a marketplace. So I sat down on the 4th of July, and I'm just reading essay after essay. And that's when it hit me that from a first principles perspective, marketplace just wasn't going to work for the demographic that we were building for, for a couple of reasons. One was that it was a monogamous relationship.

So when you're going to go find a doctor, you tend to stick with that person over time, especially if it's a specialty doctor. It's not like Airbnb where you're coming back to the platform and you want variety. You just are trying to find one person. The other thing is that it's an interesting relationship when you're trying to find like a holistic doctor where it's usually done word of mouth because it's a high trust situation. And most people are not willing to go find their holistic doctor just from the internet.

Zocdoc is a little bit unique in that they're mainly focused on primary care and dentists, which in most cases, those are more commoditized versus ours was quite specialty. And so, what I'm getting at, Brett, is that what we realized is, from a first principles perspective, the thing that we were trying to build just didn't make sense. And when I thought about it that way, it allowed me the freedom to step back and say, okay, well, what do our customers actually need? And I went back to the drawing board and started with our vision. And basically what we ultimately built after that was a Shopify like experience for starting a virtual practice. But it was that moment. I'm looking at it from a first principles perspective.

Were there moments along the way, before you decided to make the first pivot, that were false positives where you actually thought you tapped into something and then it fizzled?

Yeah. Because people wanted it. There was so much need. And we were seeing that organically. I'd get text messages or Facebook messages or emails probably every day, every other day, with someone wanting help finding an integrative or functional medicine doctor. And I was everybody's go-to person for that. And so, we knew that the need was there. But the false positive came from, yes, solving a need, but negative on ability to scale. We were never able to scale it beyond just our close group of friends or friends of friends.

It was very difficult to try to find our growth vector for it. And that was one thing. Another thing was just, it was good, not great. People liked it, but it wasn't life changing. And I really do believe that to find product market fit, it needs to be ... You get this all the time, but it does need to be a 10x better experience. And we just weren't having that.

So now version two was this sort of end to end Shopify experience, so maybe you can talk about that iteration and how that became the input into where you are today.

It's interesting, because the Shopify like experience ... So we saw a huge need for practitioners, this was pre-COVID. Actually, this was 2019. We saw a huge need for these doctors to be able to very easily build their own virtual practice. At that time, they were just throwing different fragmented pieces of a business together. You'd see them finding an EMR and then Zoom and then all these different ... Calendly, for scheduling. And there was no cohesive experience. And there were so many problems with them trying to set it up.

And so, we knew that this was a problem. It was interesting because we knew that the Shopify for virtual practices probably wasn't going to be the thing that worked. But we knew that it might lead us to the thing that worked. So if you think about it, our first product, the marketplace, the vision was to build the foundation. Hey, we're going to build the foundation where we match people in this marketplace and then we're going to build services on top for doctors. And that's really going to be your business model.

And if you think about that, it's like a layered cake where the marketplace is at the bottom. Then the approach that we went with, the Shopify, was why don't we just take a slice of it going vertical and say, we're going to do the entire experience of virtual clinic. We're going to help practitioners find patients. We're also going to build out tools they need. And the point of that was, it will lead us to where the biggest problems in trying to build a clinic this way is, and then we're going to focus on it.

So it's interesting, because the product that we built, the second iteration, I didn't actually think that that was going to be the product, it was just going to lead us there. And it did. So what we did was we challenged ourselves to launch it as fast as possible. So this sounds crazy, but we gave ourselves a one month timeline from idea to launching a clinic with a doctor and patients in a month. And we also didn't have an engineer on the team at this point. It's wild. But we ended up doing it. We launched in three states. We launched in Washington, Colorado, and California.

Had patients in each of those states. My co-founder, Rosa, and I, we were the admin staff. So we were taking notes on these calls. We were setting up the systems. And the whole point of that was to figure out where the problems were. And that's what led us to discovering the problem of lab testing.

Why did you intuitively recognize that Shopify for this audience wasn't going to work? Because you can imagine a lot of people pitching that idea and going out and raising money for it. Because in some ways, it seems like it would make sense.

That's a really good question, Brett. I guess I have my own beliefs about this, where my philosophy is to find the one very simple thing that works really, really, really well, and then expand from there, rather than to build the large thing and give it to people. One thing is that we're building with pre-seed funding at this point. The marketplace and all that was actually built off of my savings. This was built off of our pre-seed fundings. And so, we were very, very scrappy. And I wonder if we had a ton of resources. I was a second or third time founder.

I knew how to play the game. Maybe we could have done it. But I think my general belief about finding product market fit and pivoting yourself into it is finding that small thing that works. And that is so simple and obvious in retrospect. I should say, I had been building relationships with these doctors for years before this through other work and through grad school and things like that. So I knew how individualized the needs were for their systems. And it is very difficult to build one giant system, one giant Shopify and launch it and have it be modular enough to satisfy each person's different needs. And so, at least from my perspective, I didn't think that that was the best place to start.

I'd love for you to talk a little bit more about this human powered MVP that you built in that month, that then helped you get the lab wedge. Can you talk more about that? Or how you've scraped it together? Because I think that thing that you did is what a lot of founders should do. And so, maybe explaining in a little bit more detail what that looked like.

Yeah. I mean, I can talk about exactly how I came together. I'm a big believer in putting yourself out there, making it known what you're looking for in terms of support and help and the right resources will come to you in very random ways. And that's exactly what happened here. I think, when we had the idea for this, it was immediately, let's go and let's figure out how to get it done. And so, a friend had reached out maybe months prior saying, oh, if you're looking for a contract engineer, I know somebody.

So I immediately called that person and just threw the idea to him, ended up being the right fit. And so, this guy basically worked part time for us contract, found him because I was just texting friends asking if anybody knew of a contract firm or person who could help us build this. The other way is there's a lot of legal around building a clinic. And so, it could be really deterring, but our belief is figure it out and find a way. And so, I think I was having dinner with a couple friends from undergrad who I hadn't spoken to in a while.

And one of them actually worked at Curology, and they are one of the pioneers and essentially is called asynchronous telemedicine space. And so, I was very curious at how they did it state by state. And I was just grasping the laws around, essentially virtual care and all of it. And so, I remember asking her how they expanded into different states. And she said she didn't know because she was on the business side, but she would ask for their legal counsel. It's funny now to think about this. I wrote out questions for her to ask their legal counsel.

But it was written in a way where it was positioned as if she was asking about Curology, because I didn't want ... I would just basically try to figure it out from their perspective. So I'd written questions like, how did we expand from two states to five as Curology when we launched the service? Did we need one overarching physician? Did we need multiple? Things like that. And so, she took this list of questions that I'd sent her, walked into her legal department, and asked her head of legal at Curology, "How did we do this?"

And he just looked at her and he's like, "Why are you asking me these questions?" And she ended up telling him, "Oh, I have a friend who's starting a company, they're doing this." And he was like, "Oh my gosh, that's super cool. I'd love to help." And so, essentially, over a lunch, Sean, he's amazing, we're still in touch today, he helped us get started. He basically told us exactly how we could start this clinic. And so, I share that story, because that is how everything came together. There is no formal way of putting together an MVP.

It's really just asking anybody and everybody for the help you need. And somehow, if you keep going, you'll get there. I have infinite stories like that. The way we got our first doctors on board was literally cold emailing doctors and pitching this idea to them until doctors who were interested responded, and then we interviewed them. The way we got our first patients was I wrote a weekly newsletter that was essentially just about my own health journey and why this form of medicine was really beneficial and the research behind it. And it started gaining momentum.

And people would share it with one another. And in the bottom of it, I'd advertise our gut health clinic. And I'm using that virtual quotations because it didn't even exist yet, but we were advertising it and we found patients that way.

Let's talk a little bit more about as you were human powering this MVP, the process to land on the lab wedge, versus I'm sure there were other things bubbling up as you were doing this that you ruled out.

It was one of those moments where Rosa, my co-founder, and I, we used to work from my apartment, and she said, "What if we actually just solve this lab work problem?" And I look at her and it was one of the things where it was just so obvious, because it was the biggest need. The first thing we did was I just texted a few doctors I had in my cell phone. Because at this point, we had our group of close advisors I'd call them, but unofficial advisors, who we just ask, is this a good idea? Is this not a good idea?

And I think having that is extremely helpful because it helps you iterate really, really quickly. So building that kind of customer advisory board unofficial, for sure, and having them in your text message inbox, that is what helped us validate some of this stuff pretty fast. We just texted people. We said, hey, what if we actually stripped the lab portal piece out of this and gave it to you? Would this be valuable? And immediately, there was a reaction that we had not seen with the virtual clinic. What happened was for all the other products we built, we were pitching it.

Now suddenly, even with one text message, it was the doctors that were convincing us to do it. And they were telling us exactly what they needed. And there was an energy that didn't exist in the other two products. The other thing that happened was one of our customer advisory board, one of those people, she put us in touch with her friend who was launching a brand new medical practice. Incidentally, her friend had thought we already built this lab portal out.

And so, what happened was, she said, "I'm starting my practice on January and I want to get onboard with your lab portal as soon as possible because I can't start my clinic without it." She thought it already existed. And so, suddenly, we had a deadline. And it was mid-December to mid-January. That was the creation of our lab portal.

Before we continue on and pick up once you land on the wedge and how you approach starting to scale that I'm curious, when you reflect on this first year or two, was there anything you did to manage your own psychology or emotional energy? I find that once you land on something and there's a lot of pulling, it's working, it's a fuel for years. And the inverse of that can be incredibly draining and tiring when you're pushing a rock up the hill. And so, I'm curious what your own experience was in those first couple years before you landed on this thing that people were really pulling out of your hands?

Yeah. Oh my gosh, that's such a great question. Momentum is everything. Where there's momentum and growth, there's energy and exactly as you're saying, the inverse of that is completely defeating. It was so tough, Brett. I was also dealing with my own health issues, which I think are related. And a lot of founders don't talk about the health issues that you go through when building something. It is so tough. The one thing that I have done consistently since the beginning of Rupa and actually even before is stream of conscious journaling every morning.

What I do is I sit down in the morning, pull out my moleskin notebook, don't look at my phone at all, and just write everything that's on my mind. And it can be as simple as I want coffee or diving into the most difficult thing on my mind right now are all my fears. But basically, it's like getting the stuff that's stirring around in my mind out on paper has been single handedly the most helpful thing that I've done through this entire journey. So that's one.

The second thing I'll say is, when you don't have external momentum, like finding product market fit or your customers pulling you or something like that, you have to create that momentum for yourself. And for me, it can be something as simple as seeing micro progress day over day, week over week. And so, the earlier I was in my startup journey, the shorter time periods I had to construct momentum around. And what I mean by that is I would literally structure my day around, am I going to hit these things?

And if I do these things, then I am successful, and I will feel momentum. Because as humans, we're happy when we feel progress and when we feel growth. And in those times where you're trying to figure it out, it can feel like you're putzing around forever. And so, I would intentionally create daily and weekly plans that would essentially be about my own personal growth and the growth of the company to help me feel that momentum, even if it wasn't happening externally. Other examples are also creating deadlines and external pressure to hold yourself accountable.

In this episode with first-time founder Tara Viswanathan, co-founder and CEO of Rupa Health, we cover her biggest lessons on finding product/market fit and hiring the early team. 

How to pivot your way to product/market fit & other 0-1 lessons — Rupa Health CEO Tara Viswanathan

Read the article inspired by this episode

Persist or Pivot? Advice for the Pre-Product/Market Fit Days