Offcall Physician Spotlight: Meet Dr. Bhaven Murji

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1. Bhaven, what’s one task you’ve fully handed off to AI that you’d never take back? Typing. I dictate nearly everything now through Wispr Flow, paired with Speechify going the other way, because I learn by audio and association, and a screen full of correct grammar was never the point of the work. I find it distracting, in the same way that conversing with a non-English speaker can skip the non-essential words to derive the meaning.

What converted me wasn't the convenience but the speed of turning a half formed thought, spoken aloud, into a coherent instruction. Typing charges a grammar tax. You spend working memory making the sentence correct before you can make it true, and on the detailed, recursive problems I care about, that tax comes straight out of the part of my mind that should be on the problem itself. Speaking hands that attention back, and the longer the rabbit hole, the more that matters. Spoken language only loosely obeys established grammar rules.

2. Will AI solve the physician shortage or quietly make it worse? Likely neither. Some will be pulled in by the novelty, some will be disgusted enough to leave, and many patients will use AI for the cheap, triage-able questions, but it will not replace the physician at the bedside. The shortage has one true lever, the number of licensed physicians actually trained, and that lever is held shut upstream, by design rather than by fate. The House Judiciary Committee concluded in March 2026 that the National Resident Matching Program operates as a monopoly, shielded since 2004 by an antitrust exemption that keeps Match related evidence out of court, and real resident wages were higher in 1971 than they are today. The same structure that rewards the extra scan rewards the extra patient, so it absorbs any efficiency you hand it rather than giving the time back. The clearest sign is the 2026 Medicare fee schedule, which cut pay on the premise that technology had already made physicians more efficient, before that efficiency was ever demonstrated.

It is worth saying that the shortage is not uniquely American, and the workforce is mobile in ways the public underestimates. Doctors are leaving the UK in numbers that prompted its own medical association to say the NHS is training physicians for other countries, and Australia is the destination of choice. A second-year doctor there can earn meaningfully more than in England, and Australia has fast-tracked overseas specialists, the large majority of them UK-trained. AI does not touch that. A model can extend a clinician's reach, but it cannot manufacture a licensed physician, and it cannot by itself make a country a place doctors want to stay.

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3. If you could redesign residency from scratch, what's the first thing you'd change? I would clear away the noise that stands between a resident and the actual medicine. Most of what drowns a new resident is not clinical, it is the new EMR, the new system's protocols and pathways, the question of where the resources even live. I am building toward clinical decision support that puts the bread and butter within reach at the point of care, so the overhead drops and there is room left to reason. The hard part is range. Some residents are excellent and still cannot positively influence the needle beyond its setpoint, and others do not yet know what they do not know, so they drift through an ocean of possibility, go tangential, and that is where the misdiagnoses and the unnecessary tests and the avoidable harm begin, financial or physical.

When a clinician is buried in data they lose sight of the whole patient, and the whole patient is the only thing the work was ever about. A tool that sets the floor of what you must know, names it plainly, and builds learning loops out of both clinical practice and exam preparation answers both problems, and those loops carry forward from residency into the rest of a career.

4. Independent practice in 2026 — endangered species or quiet comeback? The barriers are real, corporate systems buying up the private practices and a student debt so punishing it steers doctors toward the corporate contract, which quietly turns medicine into a job rather than a calling. But equip a resident with the right tools out of the box and you cut out the middleman, restoring a direct contract of care between a doctor and a patient. That is the thing I am building toward, a pathway that carries a physician from residency into independent practice on the same set of tools, so the leap that currently feels reckless starts to feel ordinary. The paradox I keep turning over is that AI, of all things, might be what brings the humanity back, pulling American medicine out of a fearful, litigious, defensive crouch that profits from suffering and toward something built around the outcome instead. For the first time, the incentive and the work can sit in the same pair of hands, the doctor's, rather than three layers of management above them.

5. What's something you used to judge other physicians for that you now completely understand? The reflex to image early, which I used to read as a failure of discipline or abundance of resources. The judgment flipped when I saw the incentive structure behind it and the training gap underneath. In the UK, a CT or MRI request is vetted for appropriateness before the scan is taken, by a radiologist or a trained radiographer; and being totally honest as a green class of Covid doctor I got absolutely schooled, but man did I learn enough to make me chief in my second year of residency;

My default was to operate under regulations that make justification for imaging a legal step, and national audits put that vetting above ninety percent of requests.

The US has no equivalent gate, inviting error and opportunity for litigation, and it orders far more imaging, for reasons that sit closer to how doctors are paid and how afraid they are of being sued than to how sick the patients are. The oath is as much about knowing when to hold back as when to act, restraint and intervention as halves of one skill, and point-of-care ultrasound is the bedside discipline that lets you answer a question without reaching for the scanner. Lung ultrasound proved that during COVID, sensitive enough to triage at the bedside while sparing staff the exposure of moving a patient to a CT scanner. It still is not built consistently into American training, with a national survey last year finding roughly two thirds of medical schools have a point-of-care ultrasound curriculum at all and fewer than half assessing whether students can use it. You cannot fault a clinician for reaching for the tool they were trained to reach for. The behaviour was never the problem, only the architecture that shaped it.

6. If you had a magic wand for one thing in medicine — not your whole career, just one thing — what would you fix tomorrow? It is less one fix than undoing one inheritance. American medicine was built after the Second World War around workplace benefits rather than universal access, when wage controls pushed employers to compete for scarce workers with health insurance, and the tax code then made that arrangement the permanent backbone, with no equivalent break for anyone buying coverage on their own. A system assembled to attract talent rather than to distribute care put its richest rewards where the money already was, in specialty and procedural work, and the fee schedule has undervalued cognitive care ever since. So the prestige hierarchy we train inside has almost nothing to do with knowledge or risk. Neurosurgery and dermatology sit near the top together despite risk profiles that could not be more different, because both pay well, and the board score a student needs to enter a field has quietly become a proxy for its pay rather than its difficulty or its stakes.

The contempt people imagine lands only on the GP actually falls across primary care, and hardest on the specialties that do not command a high score, even though the knowledge they carry is broad rather than narrow. Meanwhile the incentive to choose that work keeps shrinking, low pay stacked on top of the documentation and the in-basket that now fill the day. OB/GYN is the interesting exception, climbing in competitiveness only recently and partly because it has come to be recognised as a surgical specialty rather than sitting outside that older, male-dominated prestige, which is its own quiet comment on what the hierarchy actually rewards.

None of this means the American system does nothing well, and I want to be careful, because the easy move is to stand inside one system and pretend the others are paradise. The US remains the place advanced care moves fastest if you are insured, and it is still the engine of medical innovation and clinical trials and new drugs that the rest of the world quietly runs on. Shows like The Pitt have done something useful by putting the strain on that system in front of the public. But people sometimes ask why I came here, and whether I should go back to where I came from, and the honest answer is that the country I trained in is hemorrhaging doctors too. They are leaving for Australia, and the interesting question is what Australia is doing that both the UK and the US are not. It spends close to half what the US spends as a share of its economy and gets better measured outcomes for it, it covers everyone through a public system braided together with private options, and it pays and regards its GPs as the specialists they are rather than as the bottom of a ladder. It is not utopia, its bulk billing is fraying, its public queues and rural gaps are real, and its own GP shortage is precisely why it courts the doctors I trained alongside. The fix I would wave a wand for is the humility to study systems that made different choices, and to stop pretending the way American medicine is built is the way medicine has to be.

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