Just recently here on Inc.com we reported on new numbers from the Kaufmann Foundation that show exactly how a startup visa--which makes it easier for foreign founders to come to the U.S. to start businesses--would benefit the economy. But reforming the process of bringing entrepreneurs to America isn't just a matter of 1.6 million new jobs and a 1.5 percent bump in economic growth.

Behind these numbers are human stories of talented folks facing very frustrating experiences getting their visa paperwork in order to come here and employ Americans. Examples of what America is missing out on abound but rarely are they as clear cut as that of Gautam Sivakumar.

One Entrepreneur's Winding Road to a Visa

The founder of Y Combinator-backed Medisas, which is building software to help reduce medical errors and improve hospital workflows, Sivakumar is a fully qualified British medical doctor (and skilled programmer) creating life-saving technology that is backed by some of our country's most well-known investors including Andreessen Horowitz and SV Angel.

I spoke with him back in February about how being a doctor influenced his approach to entrepreneurship, and in the course of our conversation he mentioned he was currently living in his childhood bedroom in Northern England, working nights to remotely lead his Bay Area-based team, closing six-figure deals while his employees toted him around hospitals via a video link on an iPad, and waiting for his visa to come through.

Intrigued about how a guy with his impressive credentials could be having such problems getting his paperwork in order, I checked back in with Sivakumar periodically over the last six months as his case wound its way through a lengthy and less-than-transparent process of requests for more information, unexplained delays, and threatened rejections. Originally, he and his lawyer thought the process would take about a month. He finally got his visa just three weeks ago, more than a year after first applying.

Advice for Other Foreign Founders

His story is first and foremost an illustration of just how hard this country can make it for some supremely promising entrepreneurs to set up businesses here. I called Sivakumar to get his take on what he learned going through the process and what advice he might have for other entrepreneurs looking to make the leap and come to America. Turns out, he has a ton to offer:

  • Ask yourself: Do I really need to be in the U.S.? There are lots of vibrant places to start a business these days--London, Berlin, Tel Aviv are all hopping. "There are places all around the world where they are really trying to nurture technology startups," he says. "Do you really, really need to be in the U.S.? Ask yourself that question because it can be a protracted process."
  • Don't cheap out. If you're bootstrapping, the whole kit and kaboodle of getting a visa isn't cheap (Sivakumar ballparks it as generally around $10,000 to $15,000 all in, though circumstances can vary substantially), so you might be tempted to try and cut corners. Resist that temptation if at all possible. "Without [his lawyer] Peter Roberts this whole thing would have been a nightmare," Sivakumar says repeatedly. "Don't scrimp. Ask around. Get a great lawyer. If you have to pay for expedited processing, pay for expedited processing."
  • Look at all your options. There are lesser known possibilities such as setting up a subsidiary of an existing foreign company and essentially transferring yourself to the States, so make sure your lawyer researches your options thoroughly.
  • Opt for openness. "Being transparent with team members and clients is really important," Sivakumar says.
  • Expect getting a visa to be a full-time job. "Having co-founders or a great team really helps because you can focus on the visa. I used to joke with the team that I had three or four full-time jobs--being the CEO of Medisas and visa guy," Sivakumar laughs, but jokes aside, getting a visa is an intensive process. Be prepared to dedicate adequate time to it.
  • Have a backup plan or two or three. This is an inherently uncertain process, so plan for that uncertainty. "Have a few backup plans in the works," Sivakumar says. Medisas considered opening an office in Vancouver, scheduling international off-sites, and various other options in case the process dragged on even further, for instance.
  • Be honest with officials. "You may be tempted to maybe jazz one area up a bit. No. Be brutally honest because if you get caught, and there's a good chance you will be, then you're done," he advises.
  • Political support can help. If things go wrong, enlisting politicians to look into your case can help (and seemed to be key to getting Sivakumar's case resolved). "There are lots of politicians who would like to foster entrepreneurship and you can write to them and say, 'Hey, this is the situation. Do you think you can help?' They can't do anything to bend the law, but they can raise the issue with the right people," and find out what's going on, Sivakumar says.
  • Leverage technology to stay productive while you wait. Sivakumar and his team leaned heavily on tools like Skype, FaceTime (recall Sivakumar's floating head on an iPad talking to hospital CEOs) and Sqwiggle to continue to accomplish things while his application was tied up.
  • Remember why you're doing it. "Medical errors in the U.S. are the third biggest killer. Based on the research we have seen, we could probably reduce that by half or so. So if we could replicate this across the U.S. in every single hospital, we have technology that would be like curing diabetes a couple of times over," he says. You need strong motivation like that to drive you if you're going to go down the visa rabbit hole and keep your sanity. "It's not something you do just for yourself."