Welcome back to On/Offcall!

Dr. Robert Wachter is an absolute legend in healthcare. As the Chair of Medicine at UCSF and a true pioneer in patient safety and digital innovation, he’s spent decades shaping how technology, policy, and clinical care intersect in the real world. 

This week, we were honored to welcome Dr. Wachter to How I Doctor for a wide-ranging conversation with Offcall co-founder Dr. Graham Walker about how AI is transforming medicine. 👏Dr. Wachter’s new book A Giant Leap is about to hit shelves and it’s all about how AI will fundamentally transform healthcare (pre-order it here!). He’s convinced AI won’t replace doctors, but he’s equally convinced that it will force medicine to reckon with what humans should actually be doing, what machines might do better, and how we can redesign care without losing judgment, trust, or humanity. 

From clinical decision support to de-skilling and documentation to trust, he and Graham dive first into every hot topic of how AI is reshaping the physician workforce, including:

🧠 How AI is already changing decision-making, documentation, and medical education
⚠️ Why “de-skilling” isn’t always bad, but blind trust in tech is
⏳ How the system’s dysfunction created an opening for AI that we can’t ignore
🛑 What it will take to adopt AI tools without losing clinical judgment, professional identity, or human connection

Out now! Listen to the full episode on Offcall

Also see Graham’s post with his own personal takeaways from the conversation and drop him a comment on social media with your reaction to the episode here.

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

NEW: Physician Spotlight With Dr. John Dayton, Stanford Assistant Professor, Intermountain Physician, & Healthcare VC!

1) John, what’s one boundary you wish you had set earlier in your career? I wish I had learned sooner that being available all the time doesn’t make you a better doctor, it just makes you a more exhausted one. This extends to doing work outside of clinical practice. When I started working with venture funds and advising digital health companies, I’d meet whenever they wanted. Often this led to me taking afternoon calls when I was in the middle of a set of night shifts. That basically meant I was meeting with them at 2AM. I didn’t have the confidence to change the time and I didn’t realize they were fine connecting in the early morning or late afternoon. Don’t make that mistake.

2) What AI tools have made the most impact on your practice and why? I’m a big fan of clinical decision support tools like OpenEvidence, Vera Health, Doximity’s DoxGPT and UpToDate Expert AI. I use these for particularly challenging clinical situations, but I also use them to personalize discharge instructions for my patients. Even though clinical decision support tools are sexy, as a healthcare investor and startup adviser, I’m particularly interested in AI operational tools, such as how AI can improve efficiency with clinical scheduling, improve workflows, and be used to provide patient summaries for transition of care.

3) What’s a health hack/routine you do personally that could benefit other doctors or your patients? As an emergency physician, I’ve started using wearables and trackers for my sleep, and made specific changes with my scheduler. It’s not safe to let your sleep-wake cycle be driven by Adderall and Monster drinks, and that’s pretty much what I did for the first 10 years of my career. As I’ve gotten older, I’ve also talked to my scheduler about reducing my day to night switches. He was great about letting me work a month of day shifts alternated with a month of night shifts. The catch was that I had to find another doctor in my group willing to have the opposite schedule. As you can imagine, this wasn’t a hard sell and this new schedule has been working out very well for us.

4) AI just prescribed medications autonomously in Utah. Should doctors be scared or embrace this?I have a hot take: Many are focused on physicians being replaced by this technology, however after I did a deep dive with Dr. Byron Crowe from Doctronic, I have a different opinion. Rather than replacing physicians, Doctronic has set up an augmented workflow for medical refills, which is a time intensive but low-cognitive load process. Just like we’ve protocolized management for several disease processes, Doctronic has a physician-driven protocol for medication refills that involves identifying the patient, identifying their medical history, has questions related to side effects and drug interactions, and has in-patient pharmacy-level checks. Rather than replacing physicians, Doctronic has built a physician-led process based on best practices, with physician-driven escalation and checks. My feeling is they’re actually setting a standard for how physicians should lead and oversee digital health and AI solutions.

5) Who do you want to nominate for the next physician spotlight?? As a physician who loves medical innovation, I’d love to hear from physicians who are building solutions as well as physicians who are funding those investments. This includes builders like Avo’s Dr. Yair Saperstein and Doctronic’s Dr. Byron Crowe as well as healthcare investors like Lightspeed’s Dr. Brenton Fargnoli and a16z’s Dr. Vineeta Agarwala.

Have a response for Dr. Dayton? Reply to this email directly, he’ll personally read every message. Also, let us know who we should feature next!

Best Things to Read This Week

What Physician Executives Really Think About ChatGPT for Health (Forbes)
MD leaders share what they’re actually seeing with ChatGPT: from patient preparation and empowerment to mental health risks, medication safety, and where clear boundaries are essential. From Sylvana Quader Sinha and featuring: Dr. Chethan Sarabu, Dr. Shikha Anand, Dr. Lorraine Muluka, Dr. Mahek Shah, Dr. Geeta Nayyar, Dr. Robert Korom, Dr. David Pares, Dr. Snehal Patel, Dr. Anurag Mairal, and Dr. S. Yin Ho.

The NYC Paradox: Why a Vetted Doctor Can’t Work Three Blocks Away (Marc Ayoub)
Dr. Marc Ayoub published a manifesto about our broken credentialing system and why it is that a clinician at NYU Langone Health gets treated like a total stranger at Mount Sinai Health System. Worth reading!

Health Insurers in Shock After Medicare Holds Line on 2027 Payments (WSJ)
Big companies lose $96 billion in market capitalization after Medicare proposed a relatively flat rate increase for next year. Also see: Insurance CEOs’ no good, very bad day on the Hill from Senior Reporter at Healthcare Dive Rebecca Pifer Parduhn.

Obamacare enrollment drops to about 23 million people for 2026 (Reuters)
More than a million fewer Americans have signed up for Obamacare plans for 2026 as monthly premiums for many soared due to the expiration of extra COVID-19 pandemic health insurance subsidies.

American Academy of Pediatrics releases childhood vaccine recommendations that differ from CDC (CBS News)
Quoting Dr. Andrew Racine, Dr. Amanda Kravitz, and Dr. Céline Gounder: The American Academy of Pediatrics released its recommendations for childhood vaccines this week, breaking significantly with the guidance released by the CDC earlier this month.

“It's not bullying if I do it to everyone” (Science Direct, h/t Dr. Wendy Dean)
From Dr. Linda Dykes, Dr. Polina Mesinioti, Laura Sheard and Rebecca Rigney: What are the red flags of a toxic healthcare workplace culture? A qualitative study of #MedTwitter responses from UK NHS healthcare professionals.

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.

👏 Well said, Kristin Flanary
Kristin Flanary, aka Lady Glaucomflecken, posted and heartfelt essay about the importance of physician communication and why the best doctors are not the most intelligent, they’re the ones that patients trust with the worst news. Read it here.

📚 Go and buy the book, S. Yin Ho
Dr. S. Yin Ho’s new book Rushing Headlong: Health IT’s Legacy and the Road to Responsible AI is now available in all e-reader formats worldwide! Learn more and download the book here.

📚 Buy yet another book, Sandeep Palakodeti
Dr. Sandeep Palakodeti published a new book “The Ultimate Asset” to help high-achievers optimize their biology before their system crashes. Learn more and download it here.

🎙️ Give it a listen, Yuri Fesko
Dr. Yuri Fesko, Chief Medical Officer at Quest Diagnostics was featured on the Value Health Voices podcast from Dr. Amar Rewari to discuss the mechanics of the Clinical Laboratory Fee Schedule (CLFS) and the money flows and policy battles behind the most common interaction in healthcare. Give it a listen here.

🎙️ Yet another great podcast, Omkar Kulkarni
Omkar Kulkarni interviewed Tom Priselac, President Emeritus Cedars-Sinai Health System and Dr. John Brownstein, SVP & Chief Innovation Officer at Boston Children’s Hospital about how AI will reshape pediatric healthcare. Give it a listen here.

🤔 Fascinating work, Andrew Wong
What operational AI lessons can healthcare learn from other industries? Dr. Andrew Wong published a new NPJ article along with Dr. Christopher Longhurst, Dr. Brahmajee Nallamothu, and Dr. Karandeep Singh about the lessons for health from other industries when it comes to AI in clinical operations. Read it here.

👀 AI gathering to watch, Anthony Chang (h/t Dr. Rubin Pillay)
Dr. Anthony Chang hosted an AI Leaders for Healthcare conference in Newport Beach featuring a superstar physician panel including: Dr. Rubin Pillay, Dr. Arlen Meyers, Dr. Ashley Beecy, Dr. Karandeep Singh, Dr. Muhammad Mamdani, and Dr. Thomas Kannampallil. See more details here.

🎉 Congratulations, Abdul Waheed
Dr. Abdul Waheed announced that he passed his Healthcare Administration, Leadership, & Management (HALM) board exam and is now a proud holder of Certificate of Added Qualification (CAQ) in HALM with Family Medicine board certification. Congratulate him here!

👏 Thank you for the reminder, Joel Bervell
Dr. Joel Bervell posted an incredible video about why if he had listened to his doubters, none of the amazing work he does today would exist. Such a powerful reminder, watch it here!

P.S. Coming Soon…

👀 Graham checked two items off his personal bucket list this week: ✅ Meet Yann LeCun. ✅ Make him think. We have something special in store, stay tuned…

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