Welcome back to On/Offcall!

Why are physicians banned from owning hospitals? 

And why would repealing the ban help fix healthcare? 

This week, we were honored to invite Texas Spine Care Center physician and nationally-recognized healthcare policy expert Dr. Adam J Bruggeman to contribute a thoughtful physician op-ed to Offcall about his work in Congress to overturn Section 6001 of the Affordable Care Act. 

If you’re not familiar with Section 6001, it’s the hotly debated provision that prohibited new physician-owned hospitals from participating in Medicare and froze expansion of existing ones. The stated goal was to protect patients, but according to Dr. Bruggeman, the policy should be judged on outcomes and the data is remarkably consistent: “Physician-owned hospitals are treating comparable or sicker patients and obtaining equal or better outcomes. Physician-owned facilities also tend to operate with leaner administrative structures and lower overhead than large consolidated systems.”

Dr. Bruggeman could not be more clear in his call to action: “Healthcare does not improve when competition disappears. It improves when patients have options and physicians have autonomy to build high-quality systems of care. Repealing the ban on physician-owned hospitals is not a partisan issue. It is a pro-competition, pro-patient, pro-community reform. Independent physicians remain one of the most stabilizing forces in American medicine. If we want a healthcare system that prioritizes access, quality, and affordability, we should empower physicians, not prohibit them from building effective healthcare systems.”

Do you agree that it’s time to overturn the ban on physician-owned hospitals? 

Read and share the entire essay here.

And also reply directly or add your response on this topic in the comments!

How Doctors Can Find Their Social Media Voice and Fight Wellness Misinformation 

👏 This week, we were equally excited to welcome Dr. Franziska Haydanek to How I Doctor. Dr. Fran has over 1 million followers across TikTok and Instagram, and now makes more income from her videos than what she makes clinically as an OB-GYN. As a medical content creator, she regularly uses her platform to explain women’s health clearly and also to call out misinformation on social media.

She and Offcall co-founder Dr. Graham Walker get real about how Dr. Fran has managed to build a growing social media business and what that means for the rest of us. Together, they break down:

👉 The economics of being a physician creator and how much money there is in health information
👉 The professional tension of earning more from creating videos than working in the clinic
👉 How we got here: Shrinking visit times that created an education vacuum which patients are instead filling with algorithms
👉 Whether clinicians have an obligation to show up digitally, in the spaces where our patients are
👉 How to build influence ethically — without compromising our license or integrity

👀 If you care about the future of medical authority in the digital age, this episode will challenge how you think about your role as a physician.

Listen to the full episode on Offcall (Also see the episode’s post on social media!)

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Most Talked About On Offcall

Physician Spotlight: Dr. Adam Brown

5 questions with Emergency Medicine physician, business school professor, start-up adviser, and Founder of ABIG Health Dr. Adam Brown (who was nominated by previous Physician Spotlight recipient Dr. Owais Durrani!)

1. Adam, you author a biweekly column “Prescriptions for a Broken System.” So what’s one policy reform that would truly change U.S. healthcare? If you read through “Prescriptions for a Broken System,” there’s a consistent theme: Consolidation. 

The scale of consolidation in American healthcare is staggering. Most people — including clinicians — don’t realize that between UnitedHealthcare, Aetna, Cigna, and Humana, more than a trillion dollars of healthcare spend is concentrated in just four entities. And it’s not just insurance anymore. These companies own physician groups. They own PBMs. They own pharmacies. They own data infrastructure. They influence reimbursement, supply chains, technology platforms, and care delivery models. When you vertically integrate insurance, care delivery, pharmacy benefit management, and retail pharmacies under one umbrella, the power imbalance becomes enormous.

If there’s one reform we should be talking about more seriously, it’s meaningful antitrust enforcement and structural separation in healthcare. Transparency alone isn’t enough. We need to examine whether vertical integration at this scale is compatible with competitive markets and patient-centered care. Until we address consolidation, we’re rearranging deck chairs.

2. What’s one innovation in medical devices or U.S. healthcare startups that excites you most? The company I founded, ABIG Health, works with innovators from early stage companies to major international medical device companies across the spectrum, helping them navigate the complexity of the U.S. healthcare market — including AI-assisted decision support tools, physical medical devices, digital therapeutics. The creativity is remarkable. What excites me most isn’t a single gadget. It’s how technology is improving workflow, documentation, research synthesis, and patient engagement. We’re seeing tools that reduce friction for clinicians, accelerate clinical insight, and even reshape treatment modalities.

I mean, who would have predicted that a video game could treat depression? Yet digital therapeutics are demonstrating measurable impact in areas we once thought required only pharmacology or traditional therapy. The real innovation isn’t just hardware or software. It’s integration — technology that fits into real clinical workflows rather than disrupting them.

3. What AI tools have made the most impact on your practice and why? ChatGPT, Claude, and Perplexity have all been useful tools for rapid synthesis of information. To be clear — and this is critical — you must verify everything. Cross-reference studies. Confirm citations. AI can hallucinate, and overconfidence in these tools is dangerous. But used responsibly, they can dramatically accelerate research discovery, help organize thinking, draft outlines, and summarize complex literature quickly. For busy clinicians, that time savings is meaningful. AI isn’t a replacement for clinical judgment. It’s an assistant — and a powerful one — if you treat it that way.

4. Speaking of AI, ChatGPT just launched Health — will this be good or bad for doctors? This framing is too binary. Very little in medicine is purely good or purely bad — and technology certainly isn’t. ChatGPT and similar tools can absolutely be helpful for clinicians. They can assist with quick literature summaries, drafting patient education materials, structuring emails, even helping organize complex thoughts. In a system drowning in administrative burden, any tool that reduces friction has real appeal. And if we’re being honest, doctors are already using these tools. Quietly, informally, but consistently. Many would tell you it’s a net positive in terms of efficiency. That said, the concerns are real. We still haven’t fully grappled with the regulatory framework for AI in healthcare. Globally and nationally, we’re operating in something closer to the wild west than a well-governed ecosystem. Privacy and security remain open questions. What happens to the data? Is it retained? Is it anonymized? Can attribution be made? Could it be sold or used downstream in ways clinicians don’t fully understand?

Like most technologies, the tool itself isn’t the issue — it’s the guardrails. We need education for clinicians on appropriate use, strong privacy protections, and clearer regulatory standards. If we get that right, AI can be an accelerant for good. If we don’t, it introduces risk at scale. So I’d say it’s not about fear or blind embrace. It’s about disciplined adoption.

5. Here’s another hot button topic: AI just prescribed medications autonomously in Utah — should doctors be scared or embrace this? Utah’s recent move to partner with a health tech startup to use AI for prescription renewals may look narrow — just renewals, just a pilot — but I think it points to something much bigger. On the surface, it sounds like the future technologists have been promising: less administrative burden, faster renewals, fewer routine tasks clogging a physician’s day. And there’s no question that clinicians are overwhelmed. If automation can safely handle low-risk, protocol-driven renewals, that’s worth exploring.

But here’s the part we shouldn’t ignore: this initiative works because existing regulatory frameworks were flexed in advance. And that’s the real signal. Our current oversight systems weren’t built for software that doesn’t just assist clinicians, but initiates action. When an algorithm renews a prescription, is that decision support — or is that practicing medicine? At what point does software cross the line from tool to provider? As AI moves closer to the point of care, governance becomes more complex, not less. Is the FDA equipped for this? How much room should states have to experiment ahead of federal standards? And are we comfortable allowing automation to take on responsibilities traditionally reserved for licensed professionals?

I don’t think physicians should be scared. But I do think they should be engaged. This feels less like a small pilot and more like a stress test for how we regulate AI in clinical practice. The question isn’t whether this is coming. It’s whether we’re designing the rules thoughtfully enough.

Finally, who would you nominate for the next Physician Spotlight? Dr. Lara Zibners, founder of Calla Lily Clinical Care!

Read the entire spotlight on Offcall here. Have a response for Dr. Brown? Reply to this post directly or leave a comment, he'll personally read every message. Also, let us know who we should feature next by replying directly to this post!

4 Things to Read This Week

Primary care is in trouble. Doctors are banding together to increase market power (NPR)
Thousands of primary care practices are forming IPAs to increase their market power, change the way they get paid, and remain in control of how they treat patients.

AI Scribe Use in Residency Training: A Call for Specialty Society Guidance in Graduate Medical Education (Advances in Medical Education and Practice)
“AI scribes may represent a potential tool to alleviate resident documentation burden, yet the absence of resident-specific guidance remains a critical gap in graduate medical education guidelines. The prompt development of clear, resident-focused guidelines is essential to ensuring AI scribes are integrated into residency training safely and effectively.”

Medical misinformation more likely to fool AI if source appears legitimate, study shows (Reuters)
“In tests of 20 open-source and proprietary large language models, the software was more often tricked by mistakes in realistic-looking doctors' discharge notes than by mistakes in social media conversations.”

2026 Healthcare AI Trends (Guidehouse & HIMSS Survey Report)
From experts Erik Barnett, Michael Duke, and Truc Taylor: “48% of healthcare leaders cite cybersecurity and data privacy concerns as top barriers to AI adoption.” Also see Offcall’s 2025 Physicians AI Report on the same topic.

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.

🎙️Give it a listen, Craig Joseph
Dr. Craig Joseph, former How I Doctor guest (!), sat down with pediatric cardiologist Dr. C. Becket Mahnke and CMIO at Confluence Health to discuss the topic every health system claims to care about but rarely operationalizes well: clinician well-being. Give it a listen here.

✅ Thank you for sharing, Michael Hobbs
Dr. Michael Hobbs shared a new study from Hint Health which measured patient satisfaction with DPC care and found that DPC care yielded a Net Promoter Score of 85, representing “a level of patient trust and advocacy that the traditional system simply cannot match." Read the study here.

‼️ Important questions, Elizabeth Vainder
Dr. Elizabeth Vainder shared her thoughts on a red-hot important topic: “If AI “beats physicians,” then why are physicians still holding the liability? We’re seeing a lot of “99% accurate.” “Outperforms doctors.” “Superhuman diagnosis.” Okay….Then why am I the one signing the chart?” Read it here!

🎉 Congratulations, Eric Anderson! (h/t Dr. Kathrin LaFaver)
Dr. Eric Anderson is joining Lin Health as its first Chief Medical Officer, where he will help advance evidence-based, whole-person chronic pain recovery. Read his announcement here.

⭐⭐ Bravo, Owais Durrani and Pamela Buchanan
We highlighted ER physicians Dr. Owais Durrani and Dr. Pamela Buchanan who were recently featured on Offcall’s Physician Spotlight series and had impassioned answers to the question: “What do you think the public most misunderstands about being a physician in 2026?” Read their answers here!

🤯 Mindblowing, Yann LeCun
ICYMI, see Yann LeCun’s mindblowing math behind AI world models, the new AI vision he is pursuing to replace LLMs with CEO Alex LeBrun at AMI Labs. Watch the clip here and listen to his entire How I Doctor interview with Dr. Graham Walker here.

And Finally…

The Pitt strikes again!  This scene perfectly captures one of the biggest real-world challenges with AI in medicine: hallucinated details that quietly make their way into charts. See it here. 

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