This is the fourth in a four-part series about institutional patterns that leave most faculty inventions stranded. Here are parts one, two and three. This one is about what an alternative to the startup default could actually look like, and what it would take to start building one.
I asked a senior tech transfer officer at a leading research university what happens to the inventions that are useful but not fundable. The ones that are promising, sometimes even patented, but unlikely to become startups. Where do they end up?
He didn’t have to think about it. “There’s a huge number of our technologies that are seeking licensee,” he said, putting air quotes around that, “and they just kind of sit there.”
“Does that feel like a problem?”
“It’s definitely an elephant in the room.”
He had been thinking about it. Maybe you change the model. Package some of the unlicensed ones together. Give a large company rights to a group of things for relatively cheap, just to generate interest. “Historically, we’ve resisted that,” he said. “We don’t want it to be shelved. But if something’s sitting and not being licensed for twenty years, it is being shelved.”
It would be easy to assume these inventions are simply overlooked in the volume of university research. But that isn’t quite right. In reality, each one gets evaluated, protected to some extent, maybe lightly marketed, and occasionally, licensed. Tech transfer offices are reasonably good at the front end. What they don’t do, and aren’t organized to do, is take coordinated ownership of the ones that don’t become startups and move them forward.
A rapid point-of-care test for lupus, requiring no lab equipment, for a disease that takes an average of six years to diagnose. A portable biopsy device for settings without fully equipped hospitals; the kind of tool that could transform cancer detection in places that currently have none. A wearable device for continuous pain monitoring in patients who struggle to self-report, such as people with dementia, or intubated patients, or young children. A soft exoskeleton for the partial ankle paralysis that affects roughly two million Americans after stroke, for which the current standard of care is a rigid plastic brace that’s been on the market for decades. An ultrasound gel formulation that stays warm, because the current one doesn’t, and everyone who has ever had an ultrasound knows exactly what that means.
These inventions have almost nothing in common except that the current system has no idea what to do with them. Each lacks an owner, someone responsible for deciding what to do next and making it so. What evidence is sufficient, what vendors to hire, which clinical community to organize around, how much and what kind of capital belongs behind it, and whether it should be licensed, piloted, built directly, or sold.
The startup became the default response to this problem for a reason. It gives an invention a clear owner. Traditionally, that means handing a small group of people a bundle of capital, decision-making authority, risk and day-to-day responsibility, and telling them: Yours now. Move it forward. When the market’s large enough and the idea has an attractive enough return profile, that works exactly as intended.
But it’s a mistake to treat this useful organizational solution as a universal one. For inventions that can’t justify a venture-backed company around them, this ownership function never materializes. When the tech transfer office is done with its patenting, cataloging, and profiling in the university newsletter, no one is there to take it forward.
A startup is just one answer to the coordination problem surrounding an invention. There are others. Licensing arrangements built around active development rather than passive marketing. Product studios that take inventions through to commercialization. Disease foundations or professional societies sponsoring development of the products their members need. Funds capitalized through royalties rather than equity. None of these are exotic; they exist in adjacent sectors. But they rarely show up in healthtech, where the startup default has been so dominant that it has left them largely unexplored.
For most of these inventions, the ownership model I find most promising is a portfolio. A portfolio runs multiple programs through shared infrastructure, so what one figures out becomes available to the next.
It mixes programs that are close to market—with simpler regulatory paths, existing reimbursement, or buyers already identified—alongside others that are earlier, slower, and more uncertain. The faster ones generate revenue that subsidizes the longer ones. No single program has to carry itself, as long as the portfolio does. This is what allows the portfolio to work without the fiction that any one program has to be a billion-dollar opportunity. The ultrasound gel and the soft exoskeleton don’t survive in the venture market as standalone bets. They can exist, and productively, as part of a portfolio.
That mix extends beyond stage. The optimal portfolio wouldn’t be limited to medical devices, but would draw from adjacent categories such as lab tools, training devices, and consumer applications. Different timelines, regulatory burdens, and buyers mean progress in one area isn’t undercut by delays in another.
In this kind of organization, most programs are held and operated rather than sold. Some can be out-licensed or exited when the right fit and buyer turn up, but that’s not the organizing objective. Instead, what builds up over time is the operator’s ability to move products through the same predictable bottlenecks: prototyping, vendor selection, regulatory strategy, reimbursement judgment, buyer access. The next program starts cheaper and moves faster than the one before it, and that accumulated velocity is the asset.[1]
Within an organization like this, ownership doesn’t need to claim the life of the inventor or require recruiting a founder to build a company around a single asset. It can live with an operating entity whose job is to decide which inventions to adopt, which to move forward, which to stop, what infrastructure to share, what evidence is sufficient, and what buyers matter.
That opens up roles for faculty inventors that the current system doesn’t have. The startup-per-invention model effectively asks them to take on second jobs—careers, really—finding time they don’t have to acquire new skills, and spending nights and weekends on cap tables and pitch decks instead of the problems they actually understand. Many decline, and reasonably so. A portfolio offers something closer to what many of them want: a meaningful stake in the outcome, a part-time advisory role organized around their domain expertise and clinical network, and someone else doing the operational work. The scientific judgment that produced the invention stays in the program. The inventor stays in their lab, their clinic, their classroom.
A portfolio also creates a place for a kind of talent that healthtech underuses. Scientifically trained people who may not want academic careers but can learn commercialization by working across programs. Regulatory strategy, vendor management, and reimbursement are teachable. Scientific judgment, comfort with ambiguity, and curiosity about clinical problems are harder to acquire late. A portfolio gives junior experts a way to build those skills without pretending that each invention needs a founder-CEO.[2]
How the portfolio is organized matters as much as what it holds. Get the shape wrong and the overhead you meant to avoid reassembles itself one layer up. Too many buyer types, sales motions, and regulatory environments to manage at once.
Better to organize around a product category—diagnostics, surgical tools, training aids—where programs share buyers and commercial infrastructure across very different clinical applications. Or around a clinical pathway, where the same clinicians see the patient through every product and commercial relationships compound rather than being rebuilt each time. Or around a site of care. Infusion centers. Physical therapist offices. Pharmacies. Each a buyer community small enough to reach and large enough to matter.
No single university catalog is likely to contain enough mutually relevant inventions in a given domain to make the portfolio logic work. The portfolio has to draw from many. The right inventions from wherever they are. Which is partly why no university has built one.
A startup has it easier here. One product, one market, one organization that can orient around making them fit. A portfolio has neither luxury. It has to bundle products that share enough infrastructure to be worth holding together, and it has to do market-making at the level of the portfolio or the clinical community, because no single product has the gravity to pull a market on its own.
One way the portfolio can make progress on both is to work closely with professional societies. For the clinical-facing products that live inside medical workflows, society members encounter the relevant problems every day, write them up as unmet needs in journal editorials, and argue about them at conferences. The right partnership puts that knowledge to work on both sides of the effort, helping decide which inventions to take on and bringing them to the people who will eventually use them.[3]
A portfolio and a society can collaborate on a target product profile (TPP), a specification of what a product needs to do to be worth using (”a pediatric ventilator for low-resource settings needs to do X, Y, Z”). TPPs are a standard discipline in drug development, defined at the start of a program, tested against the market, and used to guide development. A society can do something similar, naming what a useful product would look like in a clinical area its members know well and letting the operating entity develop toward that spec. Any product that meets it benefits, without the society picking a winner. The TPP also makes it easier to distinguish between an improvement that matters clinically and one that just looks good on a slide.
Such a partnership can also anchor advance commitments from health systems or payers before a product is finished, turning “we think there’s a market” into “a market has already said yes.” It can pull users into design early enough that usability and workflow are worked out before launch rather than after. These partnerships take care to set up. A society endorsing the wrong product compromises both the society and the product, so the cleanest arrangements keep the society setting standards rather than picking products. Other configurations work too.
Some inventions in the catalogs are both too large for a portfolio and not good candidates for venture. Their science may be more ambitious, their timelines longer, or the capital required on a different level. A targeted antibody for a treatment-resistant infection, for example, or a diagnostic platform for neglected tropical diseases that requires multi-site validation across continents before anyone can know whether it works at scale. What exists for these kinds of projects?
Convergent Research, a nonprofit founded in 2021, builds what it calls Focused Research Organizations, time-bound teams assembled around specific scientific problems that are technically solvable and clearly important, but going nowhere. The obstacle is usually not the science but the lack of an institution organized to pursue it. Anastasia Gamick, one of Convergent’s founders, points to antibiotic resistance, which causes over a million deaths a year, as a health example that fits the pattern. The science continues to progress, but the development pipeline has narrowed for two decades. Today, almost no institution will absorb the coordination costs. No one has yet tried an FRO for it.
Renaissance Philanthropy designs and funds programs at the edge of what traditional philanthropy will touch, structuring returns through royalties and milestones rather than grants or equity. Its Buffalo Initiative focuses on ultra-rare diseases—conditions affecting only a few thousand patients—where families have often spent years organizing and funding research themselves. Here the problem is market failure rather than coordination. Opportunities too small for venture but too commercial for philanthropy. The Initiative matches capital to a ten-year development horizon and assembles a coordinating team to do the work the market has abandoned. As Sarah Constantin put it, “For a major new project to happen, it needs to be somebody’s job to make it happen. Several somebodies, really, at this scale.”[4] Healthtech has no equivalent organization that I know of. Without models like this, many university inventions that could help small but important patient populations, over long timelines, have nowhere obvious to go.
Most of what’s in tech transfer catalogs has the opposite problem. The inventions are individually too small for venture. That’s fine. The portfolio is built to hold programs that work, not to exit them, and the capital that fits it is designed to deliver debt-like returns rather than venture ones. Family offices with healthcare conviction. Foundation program-related investments, a mechanism that’s legally well-established and underused. Synthetic royalties, which have matured quickly in pharma and have no structural reason they couldn’t fund programs like these. Clinical communities organizing as their own funders, the CF Foundation being the clearest precedent. Vendors willing to take a share of future program revenue in exchange for deferred fees. None alone is sufficient. Combined, they can capitalize a portfolio at the pace its products require and generate returns that look attractive against the alternatives those investors have.
What matters as much as where the capital comes from is what it expects. The current system gives a program a year or two to show venture-scale traction, and when it can’t, it dies between seed and Series A regardless of whether the product was working. Fund a portfolio on the timeline its programs actually need, and more inventions survive.
The conditions for trying this are unusually favorable. Products that once required years and dedicated engineering teams to prototype can now be designed, improved, and tested in months. Contract manufacturers will run small batches that used to be uneconomical. Regulatory consultants who spent careers inside FDA have built practices around smaller, faster programs. The agencies are moving that way too.[5] The fixed costs that made building a full company the only viable path have come down far enough that it’s no longer the only option. Some of what sits in tech transfer catalogs was too expensive to attempt five years ago and isn’t now. No one has gone back to look.
Each invention in a university catalog is effectively a side quest. The physician who watched patients suffer through a diagnostic odyssey and spent nights designing a faster test. The engineer who sat in an ICU long enough to see the same preventable complication happen twice. The proof of concept may need another iteration, or the science more work, but the challenge is real. These are records of what someone close enough to feel it noticed and tried to fix, and they’ve already done more work than the system gives them credit for.
Most of that work now goes nowhere. The expert insight, the creative intelligence, the commitment to a possibility nobody asked them to chase. It gets disclosed, reviewed and patented, indexed and published, and quietly filed in catalogs almost no one browses. These aren’t backlogs of failed ideas. Most of what’s in them never had a real chance. They’re an ever-lengthening list of unowned opportunities, waiting for someone willing to take them on.
I’ve started building a version of this and will write here as it develops. If you’re a faculty inventor with something working (or nearly) and no interest in building a company around it, an investor interested in funding portfolios of smaller, real products, or an operator who wants to do this kind of work, I’d like to hear from you. A short note with context is perfect. Email me at dvansickle@gmail.com.
Footnotes
[1] Sometimes the right answer is even simpler. Some inventions just need someone to pick them up and build a small, profitable business around them. That mindset has mostly gone missing from the university commercialization conversation, which tends to treat anything smaller than a venture-scale company as a failure of ambition.
[2] The Rice University Innovation Fellows program has been running a version of this for five years, training PhD students and postdocs to lead commercialization of research from their own labs. Over half of their fellows are working on therapeutics, devices, or other health applications.
[3] In 2024, the American Thoracic Society surveyed 164 pulmonary researchers and found most reported significant gaps in business training, few had engaged effectively with their tech transfer offices, and many lacked access to commercialization resources. The working group called for structured external support organized around the investigator. See Vukmirovic M, Benam KH, Rose JJ, et al. “Challenges and Opportunities for Commercializing Technologies in the Pulmonary Arena: An Official American Thoracic Society Report.” Annals of the American Thoracic Society 2024;21(1):1–11. doi:10.1513/AnnalsATS.202310-872ST
[4] Sarah Constantin, “The Dream Machine,” Rough Diamonds (Substack), December 4, 2024.
[5] In April 2026, CMS and FDA announced the RAPID coverage pathway, designed to compress the gap between FDA authorization and Medicare national coverage from roughly a year to as few as two months. Eligibility is restricted to FDA-designated Breakthrough Devices, which excludes most of what's in tech transfer catalogs. But it's a meaningful signal that the reimbursement timeline may not be as fixed as it’s appeared. See "CMS and FDA Announce RAPID Coverage Pathway to Accelerate Patient Access to Life-Changing Medical Devices," FDA News Release, April 23, 2026.