Welcome back to On/Offcall!

🚨 Two absolute legends in AI…sitting together for the first time…to reveal the boldest new AI model set to take over the world…

We’re talking about the one and only Yann LeCun, the former Meta Chief AI Scientist and one of the world’s foremost pioneers of deep learning, and Alex LeBrun, the prolific AI entrepreneur, CEO of Nabla, one of the leading ambient AI technology companies in healthcare, and CEO of AMI Labs.

For the first time ever, Offcall co-founder and EM physician Graham Walker, MD took How I Doctor on the road, traveling to Nabla’s recent Accelerate conference to host a rare sit down with Yann and Alex to discuss their newest company, AMI Labs, and what they hope to accomplish in healthcare.

👀 If you thought LLMs were the future of AI in medicine… think again.

After years of building Nabla into one of the leading ambient AI companies for clinicians, Alex recently teamed up with Yann to pursue a lofty goal they hope will also have a big impact on healthcare: building world models that reason and show judgment just like humans. 🤯

Together, they cover:

🧠 What “world models” are and how they could augment clinical judgment in healthcare
📉 The current shortcomings of LLMs like ChatGPT in precision-fields like medicine
⚙️ Lessons learned from building Nabla alongside clinicians
🌍 What it means to build a new kind of AI that supports judgment, not replaces it
🩺 Which specialties are most at risk of being upended by AI world models
And more!

Don’t look now, but we have a hunch this conversation will be referenced by the entire medical AI community for years to come … Get your popcorn ready for a must-watch conversation for anyone trying to understand how AI will transform medicine. 🍿

🎧 Listen to the full episode here

Thank you to our amazing sponsor: Sevaro, the physician-led telestroke and neurology company delivering rapid, reliable virtual neuro coverage.

Know someone who would benefit from joining us? Help us grow our tent by forwarding this newsletter to your physician colleagues and subscribing here.

Most Talked About On Offcall

Physician Spotlight: Dr. Owais Durrani!

5 questions with Emergency Medicine physician, keynote speaker, Emmy-nominated host, and STEM Advocate Owais Durrani

1. Owais, what do you think the public most misunderstands about being a physician in 2026? A common misconception is that everyday physicians are simply relying on what we learned years ago. In reality, medicine is constantly evolving, and so are we. Physicians are required to engage in ongoing continuing medical education, have cases reviewed, and participate in hospital committees that shape clinical guidance, protocols, and standards of care. Many of us are also deeply involved in medical societies, contributing to policy, advocacy, and the direction of our specialties. Being a physician in 2026 isn’t just about applying existing knowledge, it’s about actively helping shape how medicine changes, improves, and adapts in real time.

2. What would you tell a first-year resident that no one told you — but should have? There will always be more to give. There’s always another patient to see, especially in the ER. You can always stay late, always help one more colleague, and the work never truly ends. That’s why it’s just as important to focus on yourself and set firm boundaries around the things that matter to you like family, relationships, or a hobby that reminds you who you are outside the hospital. Early on, choosing those boundaries can come with guilt. That’s normal. Learn to work through it. You should never feel guilty for putting yourself first. If you’re burned out, exhausted, or no longer passionate about the work, that doesn’t serve your patients, your team, or you. For me, that balance is the key to staying in this career for the long term.

3. Forget pizza parties — what’s one way you’ve coped with burnout that’s actually made a difference? For me, it’s been learning to say no. In medicine, there’s a strong sense of obligation, when a colleague or leader asks you to join a committee or take on something extra, the default is often yes. But I’ve learned that being intentional matters. Saying yes to the things I’m genuinely passionate about and saying no to the rest has been essential in keeping my plate from overflowing. That selectivity helps me regain control over where my time and energy go, and it’s made me more present and effective in the work I do choose to take on.

4. Biggest workflow hack that’s made your life easier and saved you time in your specialty? Anything that reduces after-hours charting. Using smarter documentation workflows including AI-assisted notes has been the single biggest time-saver for me. Not because it replaces clinical thinking, but because it removes low-value clerical work that drains attention and energy. I always finish a note and sign it when I disposition a patient (admit/discharge) – I still see my 2 pts/her in the ER and leave on time 90% of the time with no notes to be done at home. 

5. AI just prescribed medications autonomously in Utah — should doctors be scared or embrace this? Neither, but we should be concerned and deeply involved. Programs like Utah’s AI prescribing pilot are trying to solve a real access problem. I see patients every week who come to the ER not because of an emergency, but because they couldn’t get a routine medication refill in time. The problem is how we solve that access gap. Removing physicians entirely from certain clinical decisions sends the wrong message, that medicine is transactional and the human relationship is optional. Context, physical exams, and clinical judgment matter. A refill isn’t always just a refill. AI should be used to reduce administrative burden and support physicians, not replace them. When technology helps doctors spend more time with patients, that’s progress. When it takes doctors out of the equation altogether, we risk losing what makes medicine safe, personal, and effective.

Finally, who do you want to nominate next to get the next Physician Spotlight? Dr. Adam Brown! (Tag you’re it)

Have a response for Dr. Durrani? Reply to this post directly, he’ll personally read every message.

3 Things to Read This Week

8 Wins for Doctors and Patients in the Latest Federal Budget Deal (AMA)
On telehealth, value-based care, diabetes prevention, doctor burnout and more, here are the policy highlights that impact doctors.

Nurse Practitioners Could Practice Independently in SNFs if Bill Passes (Nurse.org)
A new federal bill could dramatically expand the roles of NPs, CNSs, and PAs in skilled nursing facilities.

Physician Assistants Want a New Name and More Power. Not Everyone Is Happy. (NYTimes)
How increased responsibilities and a push to be called “physician associates” are raising tensions with doctors.

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.

⭐ Doesn’t get better than this, Brad Goldberg
Dr. Brad Goldberg had the rare opportunity to meet with actor Noah Wyle from The Pitt and have him sign his medical board certificate while on shift at Children’s Hospital Los Angeles. The clip went viral and got featured on The Late Show With Stephen Colbert. Way to go Brad! Watch it here.

👌 Fantastic news, Bob Wachter
Dr. Bob Wachter’s new book A Giant Leap just made USA Today’s bestseller list and is the bestselling book in several categories on Amazon. Don’t miss Graham’s excellent podcast interview with Bob on How I Doctor called “What Doctors Get Wrong About AI” to learn more about the big ideas in the book.

💯 Excellent writing, Arlen Meyers
Dr. Arlen Meyers shared a thoughtful essay about some of the key reasons why doctors feel dissed and disintermediated. Read it here.

❗Important read, Purva Rawal
Two weeks in a row! Following up on last week’s newsletter, former CSO of the CMS Innovation Center Purva Rawal authored a new article in HealthAffairs, alongside Elizabeth Fowler, Isabelle Jouve, and Angela Liu entitled: “Beyond Star Ratings: Proposal For A Medicare Advantage Transparency Scorecard” and diving into how a scorecard can support accountability and provide policy makers with timely insights into plan performance beyond clinical quality. Read the article here.

🎧 Hot podcast listen, Joseph Pazona
Dr. Joseph Pazona appeared as a guest on The Direct Care Podcast for Specialists with Dr. Tea Nguyen sharing his lessons on entrepreneurship, innovation in healthcare, and mindset shifts for physicians considering alternative career paths. Learn more and give it a listen here!

❗Important share, Girish Nadkarni
Dr. Girish Nadkarni shared a new Nature Medicine study showing that performance collapses when LLMs are used as public-facing medical assistants for the general public. Read more here.

✨ Congratulations, Maulin Shah
Dr. Maulin Shah has accepted the role of Senior Vice President & Chief Health Information Officer (CHIO) at Providence. Congratulations! Learn more here.

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