Offcall Physician Spotlight: Meet Dr. Aditi Joshi

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1. What's one task you've fully handed off to AI that you'd never take back?

In my daily life, admin tasks such as organizing calendars and reminders. In telehealth shifts, same. I use ambient AI and do like it, but I don't trust it enough yet to stop checking my charts. I still find errors so my trust has not been gained back. I wouldn't go back to not using it. Just as I was about telehealth, I'm still cautious until I know it and use it more. The field has to demonstrate how well it can be used sustainably in our health space. We all should be.

2. Are you worried about deskilling — that the next generation won't develop the intuition you did because the model handled it?

Yes, absolutely. We think of deskilling as only apparent in new residents or medical students. But we, as attendings, can also lose skills if we hand them off to AI. We all know this already - we create CME for procedural skills as well as for clinical management because of it. What I worry about with younger generations of physicians is that our entire culture has moved to a place of underminding and underestimating skill and expertise. If we follow that through to AI and MedEd, it means that there is less of an importance on the time it takes to gain that experience. There is no replacement for experience and seeing patients. None. We cannot actually make this happen faster than it does. This is why AI has to be an adjunct and keep the 'human-in-the-loop' to use the catchphrase. From a philosophical standpoint, I suppose it's the fate of older generations to be ignored by the younger generations but this is not something we can get wrong. What's interesting about AI, however, is that younger generations also understand the danger of this. It gives me hope that this will result in not wanting to give over their medical training to an AI.

3. Will AI solve the physician shortage or quietly make it worse?

The physician shortage has almost nothing to do with health tech; it is administrative and the way we have to work in overburdened hospitals, needing to be more efficient under less resources is an impossible task. Add in the current increase in mis/disinformation and blaming of physicians for things that are not our fault, and we are going to see more burnout. We already see an increase in physicians retiring or going into other fields. AI cannot fix that regardless of the amount of admin tasks it takes off our plate. There has to be a cultural shift that makes health and healthcare important enough to fund and resource for the capacity people expect. It is an odd thing that the US wants the best healthcare in the world but only for some people and then wonders why our health outcomes are so poor. The answer is pretty clear. AI is not going to stop that, saying it is is a distraction.

4. If you could redesign residency from scratch, what's the first thing you'd change?

That's a tough question because residents have a lot to learn in a relatively short time. Perhaps more support and realization that burnout begins in residency. I remember when my dad was in the hospital, it was very clear to me the resident on night shift was burnt out based on his behaviour. I do not know the solution because it is the same thing that plagues all of us getting burnout but perhaps figuring out how to support residents specifically. You probably thought i'd say innovation and make sure residents learn telehealth/AI/devices etc ;). That only works when those tools are part and parcel of clinical practice. When that happens it will naturally be part of MedEd.

5. Independent practice in 2026 — endangered species or quiet comeback?

Ooh, well you're talking to a virtual care pioneer; independent practices using telehealth are not going away soon. Saying that, the federal government has starting regulating it and pushing back on some of the more nefarious practices. I'm glad of it, i've seen some pretty bad things. So yes, I see it continuing but now everyone needs to understand the real compliance around it. Doing this correctly is totally doable, by the way. Fraud is not inevitable and it's pretty easy to see where the government is coming from. So I see independent practice slowing but continuing in a safer way.

6. What's something you used to judge other physicians for that you now completely understand?

Ha, what a question! In general, i'm not the judging type. People who don't know me have assumed I have judged people who didn't want to learn about digital health, do telehealth shifts or try a new AI program. No, I never did. But I also attribute that to why I am and have been successful at getting my colleagues to listen to me about it. Don't judge their reasons, just be curious about them. I don't say this lightly; I have gotten through to some of the most stubborn archetypes of people doing this. If you need an answer, when I was younger, I probably 'judged' my colleagues who did emergency medicine simply as a job. I am ambitious and always had been so thought it was selling themselves short. Almost two decades later, I realize that it is a job; one that one cannot simply clock in and out of. No, medicine does become part of your fabric. But it is a job and it is not the only part of life that's important.

7. What did you spend money on early in your career that absolutely wasn't worth it?

Too many textbooks. Why did I need all of them? I certainly didn't read all of them. I was going to say digital stethoscopes and tools like that but I generally have been gifted them to try out. The oddest thing I have is a Mac blade. Not sure what I was going to do with that at home and I certainly couldn't use it in the hospital ;).

8. What's something physicians are quietly worried about that the public doesn't know about yet?

The undermining of science and the growth of wellness grifters. We can label it mis/disinformation also but this is having a profound effect. People are losing trust in physicians; the narrative is that we are money hungry and in the pockets of pharma or snake oil companies. Most physicians are actively fighting against this, but oddly, it's the physicians that work with wellness grifters that are not being vilified. It is so strange. The effect of this is that we are going to have a sicker population from things that are preventable and we have not created the resources to deal with it. Having only online, piecemeal clinics cannot give the full spectrum of care needed (and yes, I say this even being a telehealth proponent - it has to be hybrid). All of this together leads to a population who doesn't listen to experts, listens to those who might shill things that are useless or actively harmful, and then has consequences. The problem is that if those patients have health consequences, they have to go back into the healthcare system and see doctors who would have warned them against doing some of these harmful things. We have not even seen the long term effects of some of this and it could be immensely expensive. I worry about sustainability of all this: of resources, of our system and our workforce.

9. If you had a magic wand for one thing in medicine — not your whole career, just one thing — what would you fix tomorrow?

I'd fix our payment incentives and how we structured payment. The middlemen between pharma, insurance and clinicians has done far more to damage our system than anything else. I live in France and it doesn't work that way. It is night and day how people feel and work in that health system. I went to see a friend's ER in Lyon; the way it was setup, I would work there. It was efficient and allowed the doctors to do their job effectively. No one worried about payments or prior authorizations or if the patient could afford medicine; neither the doctors nor patients.The way we do it...it just doesn't have to be that way.