Offcall Physician Spotlight: Meet Dr. Neal Kaushal

Offcall Team

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

Medical literature research and review. My days of staying up late at night on PubMed trying to find the right search terms to get information that I need are long gone. AI has streamlined that process to make things so much more time efficient, there is really no going back for me. Having said that, knowing how to navigate PubMed and similar databases can be an important skill to have – especially in academic medical center environments – but AI has allowed the mainstream population of physicians access to an entire ecosystem of knowledge and resources that in the past may have seemed like a daunting task to navigate.

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

No. I am worried about the exact opposite. We are in the midst of an information technology revolution in medicine. Everyday there are new tools being tested and developed in order to make our lives as physicians more efficient, more patient centric, and more balanced. The next generation has access to so much new knowledge and information that they will have an entirely new platform – and responsibility – of developing innovative ways to take care of patients. I can imagine that when Dr. DeBakey designed his specialized surgical retractors, he likely did not imagine that a future physician would command a robot to hold six of those instruments in flawless position for twelve hours straight.

While clinical intuition may not be replaceable, it is up to current physicians to adapt to new paradigms, rather than the next generation being tasked with holding on to dated practices.

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

Neither. There will always be a physician shortage. Physicians are some of the few people on planet earth that have the ability to absorb, synthesize, and implement information under immense pressure while having to communicate doing all of this to strangers. Every. Single. Day. Over. And. Over. Again.

AI or not, there will never be enough of them.

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

Residents need training in business. Medicine can no longer be practiced in the clinical vacuum of “I just want to help people.” Like it or not, the business of medicine is too intertwined with patient care to the point that if doctors do not have mastery of this knowledge base just like mastery of how to read an EKG, patients will continue to suffer.

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

Depends! The idea of independent practice is making a not-so-quiet comeback. There is a palpable shift away from the employed physician model of “just show up with your stethoscope and XYZ Health, Inc will take care of the rest” to “I’m tired of people who’ve never set foot in the ICU dictating how I practice the craft I’ve worked by whole life to achieve.”

What this looks like in practice is still highly variable, and subject to market forces that – see my answer to the previous question – physicians are still a long ways away from understanding in order to make this model work for them.

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

Drinking cheap coffee. I’m a craft espresso iced latte kind of guy, but at 2:00 in the morning, yeah the vending machine will have to do.

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

It was all worth it. Once I started earning as a physician, I took full advantage of the realization that my income increased 10-fold as compared to when I was in training. I made it a point to enjoy myself and provide for my family as much as possible, and I continue to do that today.

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

On that same note, money. The “public” seems to think that physicians are “rich.” But many physicians feel anything but rich, in every sense of the word. There is so little public insight into the financial pressures of both becoming a physician and being a physician.

While the public understandably views the medical profession through the lens of guaranteed prosperity, the modern reality tells a far more complicated financial story. The visible metrics of success—like high earning potential—frequently mask the invisible hurdles of extreme educational debt and the immense opportunity cost of a decade spent out of the workforce. Furthermore, physicians operate in an ecosystem where reimbursement rates are entirely out of their control, dictating revenue regardless of the actual cost or complexity of care. Instead of clinical independence, today's doctors are often bound to rigid productivity benchmarks based on national averages—metrics that only tell a small, flattened part of the story. Ultimately, the challenge isn't just delivering exceptional care, but navigating an economic system where structural pressures are rising much faster than the actual rewards.

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

Every C suite of every hospital in the country should contain at least one physician. Or at least be considered as part of the management team. Not a CMO who is relegated to monitoring quality metrics and physician behavioral issues in the OR, but a physician should be an integral part of the core management team. Business decisions cannot be made without the understanding of what that looks like while coding a patient in the ICU. Simply put, there should be a “Rooney Rule” for physicians in management of healthcare. If you don’t know what that means, ask the AI agent that is listening to your conversation right now.