Offcall Physician Spotlight: Meet Dr. Rosy Thachil

Offcall Team

Have a response for Dr. Rosy Thachil? Reply to this post directly — she’ll personally read every message. Also, let us know who we should feature next by replying directly to this post!

Sign up for our newsletter

On/Offcall is the weekly dose of information and inspiration that every physician needs.

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

It’s nuanced.

Clinical intuition is really pattern recognition built through thousands of repetitions: seeing the patient who looks fine until they suddenly aren’t, realizing the numbers don’t quite fit the clinical picture, or recognizing that something just feels off before you can fully articulate why.

If AI removes too many of those repetitions before trainees have had the opportunity to build their own mental models, we could create physicians who are excellent at interrogating an algorithm but less comfortable reasoning independently when the algorithm isn’t there—or when it gets something wrong.

But I also don’t think the answer is to preserve inefficient work simply for the sake of training. We have to move with the times. Medical education has to evolve alongside the technology, just as medicine has evolved with every major advance before it. The goal shouldn’t be to train physicians who can compete with AI at information retrieval; that’s perhaps a losing—and unnecessary—battle. The goal should be to train physicians who know when to trust AI, when to challenge it, and, perhaps most importantly, what to do when the data or the model doesn’t give you a clean answer.

Medicine is more than information. The art of medicine is being able to sit with a frightened patient or family, understand the medical, social, and cultural context behind the numbers, recognize uncertainty, communicate difficult information, and exercise judgment when the evidence doesn’t fit neatly into a box. Those are deeply human skills, and I don’t think they’re going away. In fact, as AI becomes better at the technical and informational parts of our work, our ability to bring context, judgment, empathy, and humanity to the bedside may become more important than ever.

The goal is to train physicians who know medicine deeply enough to use AI as an extraordinarily powerful tool without ever surrendering their own judgment to it.

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

I think the answer will depend largely on how we implement it.

AI has the potential to give physicians back meaningful capacity. If it can reduce documentation, inbox work, administrative friction, and some of the cognitive overhead that consumes our days, physicians can spend more of their time doing the things that genuinely require a physician—clinical reasoning, complex decision-making, communication, and caring for patients.

But there’s an important question about what we do with that recovered capacity. We have to be thoughtful about ensuring that efficiency gains translate into better care and a more sustainable practice of medicine, rather than simply creating expectations for continually increasing productivity.

If we get that balance right, AI could help address both access and burnout by allowing physicians to spend less time on the friction surrounding medicine and more time practicing it.

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

I would broaden what we consider essential physician training.

Residency and medical training does an extraordinary job of teaching physicians how to care for sick patients, manage complex disease, interpret diagnostic studies, and make decisions under pressure. Those clinical skills are—and should remain—the foundation of medical training. But practicing medicine today requires another set of skills that we often expect physicians to somehow pick up along the way: communication, team dynamics, leadership, technology, operations, healthcare economics, and understanding how the systems around us actually work. I would build more of those skills into training rather than leaving physicians to figure them out on their own once they’re in practice.

Medicine is ultimately a team sport practiced within a remarkably complex system. You can be an outstanding clinician and still struggle if you don’t understand how to lead a team, resolve conflict, communicate across disciplines, use technology effectively, or recognize the incentives shaping the care around you.

I imagine it’s a little like training a pilot to fly the plane beautifully without teaching them how the airport, air traffic control, or the broader aviation system works. Flying the plane is still the most important part—but understanding the system around you undoubtedly makes you a better pilot.

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

Endangered species—but one worth protecting.

The economics of healthcare increasingly favor consolidation. Administrative burden, negotiating power, technology costs, reimbursement complexity, and the sheer infrastructure required to run a practice independently can make the prospect feel almost impractical.

And yet, I understand why physicians remain drawn to it. There is something meaningful about having the autonomy to build a practice—to decide how you care for patients, how you structure your team, and what kind of environment you want to create. That independence can foster creativity and innovation.

Perhaps most importantly, independent practices can serve communities, patients, and models of care that may not fit as naturally within larger systems. They can create additional points of entry for patients and give physicians the flexibility to respond directly to the needs of the communities they serve.

I don’t think every physician needs to own a practice, and large health systems certainly offer advantages for both physicians and patients. But I do think medicine is stronger when there are multiple ways to practice and multiple ways for patients to access care. If independent practice becomes so difficult that it is no longer a realistic option, we risk narrowing that landscape—and ultimately losing an important source of choice and access for patients.

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

I would fix the amount of human talent we waste on friction.

Healthcare is full of extraordinarily bright, highly trained people spending enormous portions of their day fighting systems: hunting for information, duplicating documentation, navigating prior authorizations, tracking down records, clicking through suboptimally designed software, and solving operational problems that should never have reached them in the first place.

As someone who works in a busy cardiac ICU, I know that some complexity is unavoidable. Sick patients are complicated. Medicine is complicated. There are difficult decisions that require time, judgment, multidisciplinary collaboration, and careful attention to detail. This is necessary complexity.

But we’ve somehow allowed a tremendous amount of unnecessary complexity to become part of the definition of practicing medicine. We’ve built layers of processes and systems around patient care that can sometimes consume the very resource healthcare has the hardest time replacing: the time and attention of highly trained people.

A healthcare worker spending two hours figuring out how to get a medication approved is two hours they aren’t spending thinking about a patient. A healthcare worker tracking down information across multiple systems is time that could otherwise be spent at the bedside.

And I think the same is true for patients. They spend enormous amounts of time navigating portals, phone trees, authorizations, referrals, forms, and fragmented systems simply to get the care they have already been told they need.

If I had a magic wand, and at the risk of sounding reductionist, I’d remove the unnecessary complexity so we could devote more of our time and attention to the necessary complexity.

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

Rules and regulations getting in the way of physicians' ability to use their actual clinical judgment. One example in addiction medicine is a mandatory minimum number of urine drug screens every year for patients on certain controlled medications, in certain settings or jurisdictions. This is sometimes regardless of how long they’ve been stable in recovery. It’s costly and paternalistic, and it’s another hoop that both doctors and patients have to jump through.

Other rules and regs may not impact clinical judgment, but they take up a ton of our time unnecessarily. For instance, we spend countless hours sitting through redundant corporate compliance modules (workplace safety, cultural difference, sexual harassment, how to use a fire extinguisher, etc). Similarly, there are burdensome state-specific CME requirements in many states that are required to maintain your licenses. They are often on very specific topics like HIV care or bioterrorism. Sometimes the topics have very little relevance to many doctors’ actual daily scope of practice. This stuff is time-consuming and frustrating. It's less time we're able to spend helping patients.