Welcome back to On/Offcall!

Don’t miss it! This week, we announced the guest speaker for our next AI Residency webinar session #2: Heidi’s U.S. Commercial Director Mehul Akhouri.

This is a live, hands-on session to learn how to make AI work for you: in your practice, your workflow, and your day-to-day clinical reality. We’re bringing together AI educator and direct primary care pediatrician Dr. Michael Hobbs, Offcall co-founder Dr. Graham Walker, and physicians from all across the country and would love to see you there.

🗓️ May 6th at 5PM PT / 8PM ET
RSVP now

How We Begin to Restore Physician Mental Health

On How I Doctor this week, Graham talked to an ER doctor who’s working on one of the most urgent and stigmatized crises in medicine. Dr. Stefanie Simmons is the Chief Medical Officer of the Dr. Lorna Breen Heroes' Foundation, an organization that works to destigmatize mental health in healthcare. They discuss:

✨ Why burnout is an occupational problem, not a personal failure
✨ Why seeking care should never come at the cost of your career
✨ How we challenge the structural barriers and culture that have prevented clinicians from getting the mental health care they need

🎧 And much more! Listen to the full episode

Physician Spotlight: Meet Dr. Steven Farmer

3 questions with the cardiologist and ABIG Health policy leader.

1. Steven, what do you think the public most misunderstands about being a physician in 2026? That the doctor in the room is the one making all the recommendations. Patients come in believing — reasonably — that their physician looks at their situation, applies their training, and recommends what's best. And that's still true in the exam room. But what actually happens to that recommendation afterward is shaped by forces most patients never see: what is covered, payment model incentives, and prior authorization workflows.

I spent years as a cardiologist — first in academic medicine and then working at CMS. That last chapter changed how I understood everything that came before it. The policy decisions made in Baltimore have profound clinical consequences at the bedside. A coverage determination isn't an abstraction — it's whether your patient gets the intervention or doesn't. Most physicians navigate that reality every day without the public even knowing it exists.

The misunderstanding I'd most want to correct isn't that medicine is hard — people know that. It's that the hardest parts in 2026 often have nothing to do with medicine.

2. What's one way you've coped with burnout that's actually made a difference? I redirected, rather than recovered. There's a version of burnout advice that assumes the answer is rest — take a vacation, set your phone down, find a hobby. And maybe that works for some people. For me, the exhaustion was about the gap between what I could do for a patient and what the system would allow. That's a different problem, and it doesn't respond to rest.

What actually made a difference was finding a way to work on the system instead of just inside it. Moving into federal health policy — working at CMS while continuing to practice — gave me a context where the frustrations I'd accumulated clinically became actually useful. The things that had burned me out became the subject matter. I couldn't unsee what I knew about how coverage and payment decisions landed on real patients. But I could try to make those decisions better.

That's not a path everyone can take, and I'm not suggesting it as generic advice. But the underlying principle is: if the burnout is structural, the fix probably needs to be structural too. Figure out what specifically is grinding you down — and ask honestly whether you're trying to recover from it or address it.

3. What's the hardest part about being a physician that you think should be talked about more openly? Moral injury. Not burnout — moral injury. They're related, but they're not the same thing, and conflating them leads to the wrong interventions.

Burnout is exhaustion. Moral injury is what happens when you are forced, repeatedly, to act in ways that conflict with your values as a clinician. When you know what a patient needs, but the system isn't equipped to deliver it. When you understand that the payment structure is steering your patient toward a path you wouldn't choose if the incentives weren't there. When you're documenting for hours because the system requires it, and you're acutely aware that those hours came from somewhere — usually from your patients, or from yourself.

I've been on both sides of this. As a cardiologist, I felt it. As someone who spent time at CMS, I also watched it happen from the policy end — and saw how often the people writing the rules genuinely didn't understand the clinical reality they were governing.

The conversation about physician well-being has gotten better. But it still defaults too quickly to resilience frameworks and self-care language. What I'd want talked about more openly is the specific, systemic ways that medicine asks physicians to compromise their clinical judgment — and what it costs when we do that, year after year, without naming it.

Finally, who do you want to nominate next to get the next Physician Spotlight?? I'd like to nominate Dr. Rich Bruno.

Know someone else who should be featured? Reply or tag them in the comments!

3 Things to Read This Week

Does what doctors wear matter? How dress impacts patient trust (The American Journal of Medicine)
From Dr. Leah Tudtud-Hans, Dr. Jayaram Chandrasekar, Dr. Hana Kazbour, Dr. Leena Sahay, Maverick Marpa, Dr. Armando Camacho-Santos, Dr. Matthew Cappiello, and Dr. Lawrence K. Loo: How is patient trust influenced by traditional physician attire versus surgical scrubs?

How to negotiate a physician sabbatical in private practice (KevinMD)
From Dr. Sarah Gebauer: “When I tell other physicians that I negotiated a sabbatical from private practice, a full semester abroad with my family, followed by months of extended travel, the reaction is almost always the same.”

The ER has three prime directives. Diagnosis isn't one of them (Graham on LinkedIn)
“I say this with all the love in my heart: Your ER doctor probably doesn't care about your exact diagnosis — and this is one of the many ways that media is failing in its reporting of the new paper in Science this week.”

Highlights From Our Community

Each week, we celebrate career milestones, launches, & other goings-on in the physician community. Have something to promote? Reply and we’ll feature you.

🎉 Congratulations, Saba Fatima
Dr. Saba Fatima has been promoted to Associate Professor of Pediatrics at KU School of Medicine-Wichita. Congratulate her here!

🩺 Way to go future doctors!
Congratulations to all those who will be pursuing their M.D. this fall, including Christine Kouria (here), Arnav Ajay Jadav (here), Sahil Malhi (here), Zayaan Tirmizi (here), Shameer Gondal (here), and Karina Mahida (here). If you know someone we should lift up in this newsletter, tag them in the comments too!

⚕️See you in Melbourne, Graham!
ICYMI, Graham is keynoting the Australian Medical Association National Conference this year, on the topic of: 𝗪𝗵𝗮𝘁 𝘁𝗵𝗲 𝗳𝘂𝘁𝘂𝗿𝗲 𝗵𝗼𝗹𝗱𝘀 𝗳𝗼𝗿 𝗽𝗵𝘆𝘀𝗶𝗰𝗶𝗮𝗻𝘀 𝗶𝗻 𝘁𝗵𝗲 𝗮𝗴𝗲 𝗼𝗳 𝗔𝗜. Learn more and check it out here.

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