Welcome back to On/Offcall!

This week on How I Doctor, we showcased one of the most unique individuals who we’ve ever featured on the show: Dr. Paulius Mui.

If you’ve followed this newsletter before, then you’ll probably recognize his name: Paulius is a family medicine physician who's also a game designer, educator, community builder, hackathon leader, and founder of X = Primary Care (we’ve sponsored several XPC events, see the latest below!).

Paulius’ most recent chapter may be his most important yet: He recently launched a virtual direct primary care practice that flips the entire healthcare model on its head. At a time when most primary care is drowning in red tape and burnout, Paulius built something entirely different: Patients receive unlimited access to care via text, phone, or video. They don’t need insurance. There’s no long wait times to receive care. And the kicker: It’s pay what you can. 👏

Paulius believes deeply that medicine can be rebuilt with creativity, community, and compassion at the center, and he’s actually walking the walk: “Financially, it's not the best decision for me… but if that allows patients to be seen when they need to be seen, it’s worth it.”

In the episode, he talks with Offcall co-founder Dr. Graham Walker about:

👉 Why it’s nearly impossible to be a full-time primary care doctor in today’s system.
👉 The missed opportunity of not integrating teaching into real-world care.
👉 Why creative doctors need space, community, and permission to build something better.
👉 How he built a virtual direct primary care practice from the ground up.
👉 Lessons for how other doctors can innovate in healthcare without burning out.

As an added bonus, Paulius compiled a Direct Primary Care resource guide for any physician who’s curious about what it is, or interested in starting a practice of their own. You can listen to the episode and view the guide (once you sign up for Offcall) at the link below.

Thanks for paving the way forward, Paulius! ❤️

Listen to the episode here

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Most Talked About On Offcall

Physician Builder Spotlight: David Rosen

We’re shining light on MD-entrepreneurs! Each week, we feature an entrepreneurial doctor who’s building a cool product, company, or working on a big idea that you definitely want to know about. This week, meet David Rosen, Founder and CEO of Renuma (more on the company’s mission below!). You can connect further with David on LinkedIn.

1. David, what inspired you to become a physician entrepreneur? I never would have guessed my career would go in the direction of entrepreneurship. After 7 years of residency and fellowship training, I thought I would work within one large multispecialty practice for decades, and that I’d be happy with that. But as I progressed in my career, I felt this nagging drive to “build” something that could provide patients with an efficient solution to a problem. Full-time clinical practice, although rewarding and a privilege, was not satisfying that desire. And the shifting landscape of healthcare delivery that we all experienced over the last 10 years eventually led me to develop that full-blown burnout that many of us know all too well (that’s of course a whole other interesting conversation we can have). All this led me to look for other ways I could apply my skills.

2. Tell us what your company does and what problem you're trying to solve. After years of treating sleep disorders, I started wondering why, after waiting 2 months to see me, is a patient going to wait 2-3 more months to jump through so many hoops and obstacles just to stop choking every night in their sleep? If we treated fever like obstructive sleep apnea, we would be referring every patient to infectious disease before even allowing them to check their temperature. If a patient can grab a thermometer from their medicine cabinet, I wondered why can’t we introduce that kind of simplicity for sleep apnea care? When I couldn’t find any satisfactory solutions out there, I decided to just go for it and create it. The tagline for Renuma sums it up nicely: Sleep Apnea Simplified. It is a digital health platform that helps people receive an automated sleep apnea risk assessment (no, it’s not just a STOP BANG), a home sleep study, a telemedicine consultation with a board-certified sleep medicine physician, and treatment for their sleep apnea. There’s no agenda and no financial ties with any device manufacturer. It’s just a one-stop shop for end-to-end obstructive sleep apnea care.

3. What's your advice to anyone who's thinking about entrepreneurship or a nontraditional career in medicine? Talk to anyone and everyone. You probably have a larger network than you realize of both physician and non-physician friends and acquaintances that can give you guidance in building what you want to build. You may also be surprised to learn that most people would be happy to sit with you for coffee to hear about your idea and give you insight on how to execute it. Be grateful for their time, don’t try to sell them on your idea, just soak in their knowledge and figure out how to integrate that into your startup idea. You may come away from that conversation less convinced about the viability of your idea, but that’s progress as well. Once you launch your startup (likely years later), it will probably look very different from your original conception and that’s a good thing.

4. How can a physician overcome their biggest fear to start a company? You can certainly ease yourself into it at first because every startup begins with an exploratory phase. You haven’t left your job at that point. All you’re doing is just carving out some extra time here or there (easier said than done, yes) to figure out the nuts and bolts of this idea. But eventually there IS going to become a point where you must take a leap of faith. When I reached that point (another interesting story for another time), it was helpful for me to learn that it’s very common for an entrepreneur to feel fear and anxiety about the risk they are taking. And that path can sometimes feel quite lonely because of the dead ends you encounter and the fits and starts of the process. When I realized all those feelings are normal, it gave me a sense of calm and reassurance.

5. What's the #1 lesson you've learned since building your company that wasn't obvious to you before? A lot of things will not work out as planned. There have been so many potential collaborations that looked very promising but ultimately did not work out. Once I came to understand this is a normal part of the growth process of a company, I saw those events as opportunities to help further define what my company is trying to accomplish and why that collaboration or strategic partnership would not have been positive for us.

6. Name the top resources you found most helpful to get going as an entrepreneur journey that others would benefit from? I’ve found that there’s so many resources and organizations and incubators out there that it can be quite dizzying and you can quickly go down a rabbit hole and time-wasting detour when you focus or highlight one resource. Instead, I will list 3 values that have been my guiding light in this journey:

Curiosity: This has truly been my guiding light on my winding and unpredictable career journey. It has led me down paths with unclear destinations. But trusting in my curiosity has allowed me to achieve things I would never have dreamed possible.

Respect: Understanding that every single human deserves respect has kept me centered and grounded. It takes effort to remind myself that we are all part of a team and we all make up a whole that is stronger than the sum of its parts. This is humbling and (hopefully) helps me to show anyone and everyone with whom I work that I value them.

Gratitude: Gratitude takes work, and it must be deliberate. But showing others and myself that I am grateful for who they are and what they do has really helped me build solid and trusting teams.

7. How can other physicians support you? I absolutely love connecting with other docs about my startup, their startup, or just trading stories on our entrepreneurship journey. We’re not fundraising at the moment, but I’m happy to hear from people who would like to discuss Renuma further and see if it might be a good investment fit for them when we’re ready for our next funding round. You can also get the word out about Renuma by nudging someone at risk for sleep apnea to create a free Renuma account. You just put in your name and that person’s name and email and they’ll receive a link to create an account and get a free automated sleep apnea risk assessment. Please feel free to reach out directly if you’re interested in what we’re doing. My email is: [email protected] and you can also connect directly on LinkedIn.

A few bonus questions on AI:

1. What's an actual prompt you're feeding to GPT that's been really helpful to your clinical work? Our EMR is very dated so there’s not an efficient way to have my hospital consult note submit the billing unless you want to manually search through a laundry list of diagnoses or click your mouse 100 times through clunky and poorly designed templates that waste time instead of save time. Instead, at the bottom of my own note template (which is actually just a word document with some high yield verbiage), it says “Please give me the ICD-10 codes for the following diagnoses [insert all diagnoses here] and then write all those codes on one line separated by commas.” When my note is complete, I copy/paste all the diagnoses from my word document into that bracket (it doesn’t matter if each diagnosis creates a new line) and then I copy/paste that into GPT to compute the answer. It will first list each official diagnosis and code so I can double check that the code looks right. And then at the bottom, it just gives me the codes in one short neat line for my submission to the biller.

2. What's the AI tool/use case you can't live without as a physician? At this point GPT is ubiquitous and is all things to all people. I really love how it saves me time when figuring out how to solve a database management problem for my digital health platform. It drastically cuts down the time it takes to solve an issue like that. I haven’t yet grown comfortable in having it dictate notes and patient letters for me.

3. Any top resources you found most helpful to get going with AI as a physician? When I’m trying to learn a new concept, I really find YouTube videos more helpful than an article or a Reddit post. If you’re trying to understand how a particular prompt works or are looking for some kind of functionality with AI, there is most likely a YouTube video out there that can walk you through that step by step.

This excerpt has been shortened, read the full article here. Know someone else who should be featured? Reply or tag them and their company in the comments!

Best Things to Read This Week

Live reactions to this year’s Epic UGM announcements (Second Opinion Media, LinkedIn Live)
Chrissy Farr hosted a virtual panel with a star-studded cast unpacking this week’s news from Epic and what it means for the healthcare industry! Featuring: Graham, Nabla CEO Alex LeBrun, and Brendan Keeler. Plus, for more reactions to Epic’s announcements and what it means for health tech startups, read Yair Saperstein’s op-ed in Healthcare IT Today here.

Pay Gap Between Nonprofit Hospital CEOs and Employees Grew, 2009-23 (Health Affairs)
How wage inequalities within nonprofit hospitals have grown over time. From researchers: Cal Chengqi Fang, Sabrina D. Wang, Jonathan Cantor, Christopher M. Whaley, Brian Briscombe, and Joseph Dov Bruch.

Doctors work more but earn less (LinkedIn News)
A roundup of top reactions after an Axios news report showing physicians are working more but earning less due to rising costs and stalled reimbursements. Featuring: Carolyn McCrea, Shawn Martin, Michael Bass, Simon Dobretsov, James Seramba, the California Medical Association, James Perrin, and Douglas Laher.

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.

⚕️Calling all builders, Paulius Mui
Paulius is everywhere! He’s hosting an XPC Hackathon this coming week to prototype, connect, and win $3k in prizes, featuring a keynote by Graham and mentorship from Dr. Vishnu Ravi, Dr. Jay Parkinson, Dr. Alex Dummett, and Benjamin Lee. Read more about it and apply here!

🩺 Career news, Neil Panchal
Dr. Neil Panchal is taking on the role of Chief Medical Officer at Longevitix, an AI-driven longevity medicine company. Read more about it and congratulate him here!

❗Important work, Kim Downey
Kim Downey and CEO of the Dr. Lorna Breen Heroes’ Foundation J. Corey Feist were featured on Dr. Kevin Pho’s podcast discussing the mental health crisis facing the healthcare workforce. Listen to their podcast here.

✅ Thank you, Emily Silverman

Dr. Emily Silverman hosted an important podcast conversation with Dr. Wendy Dean on the topic of moral injury in healthcare and how it’s pushing clinicians to the brink. Give it a listen here.

👀 Eye-opening post, Joel Bervell
Medical influencer Dr. Joel Bervell spoke with CBS News about his experience finding an AI-generated video of himself being used to run ads for supplements he had never seen across social media. Read more here.

👉 Get ready for it, John Dayton
Dr. John Dayton is organizing a free virtual conference hosted by the Stanford Department of Emergency Medicine called ‘Emergency Medicine Without Walls and featuring keynote speaker Dr. Eric Horvitz. See the agenda and register here.

🎉  Congrats, Marshall Frieden
Dr. Marshall Frieden is starting a new role as Clinical Assistant Professor at Baylor College of Medicine. Congratulate him here!

🤔 Interesting new series alert, Aditya Jain
Medical student Aditya Jain is sharing his reflections on LinkedIn after completing his first three weeks as a clinical student. Read Week 1 of "Diaries of a Medical Student on the Wards" here.

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