On/Offcall: 5 Doctors Share Why They've Left Employed Medicine Behind
Welcome back to On/Offcall!
“Half the patients I see in the ER could have been treated a week earlier for a fraction of the cost.”
Dr. Rishi Khakhkhar spends half his week treating patients in the Mount Sinai ER. The other half, he's building an AI-assisted primary care company called Counsel Health designed to keep more patients from ending up there in the first place.
But Rishi doesn't believe the answer is replacing doctors with AI. He calls the model “semi-autonomous care.”
AI can take the history, gather information, and help determine when a physician is needed. But diagnosis, prescriptions, referrals, and diagnostics stay with the doctor.
On this past week's How I Doctor, Rishi and Dr. Graham Walker get into:
→ Why so many patients end up in the ER unnecessarily
→ Where AI should stop and the physician should take over
→ Why he disagrees with parts of the argument that AI already outperforms doctors
→ Why medicine shouldn't rush past the human-in-the-loop stage
→ Why asynchronous medicine could eventually become its own specialty
Can AI actually keep patients out of the ER without taking doctors out of medicine?
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These Physicians Explain Why They’d Never Go Back to Being Employed
This Labor Day week, we heard from five independent physicians about what it really means to step outside traditional employment, and what they’ve gained by doing it. More autonomy. More control over their time. More say in how they practice medicine. Featuring: Dr. Ari Brown, Dr. Farzad Mostashari, Dr. Paulius Mui, Dr. Basil Kahwash, and Dr. Bradley Block.
Watch the special episode here
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3 Things to Read This Week
New primary care docs choosing the Ocean State (Brown University)
Featuring Dr. Abigail Dillon, Dr. Kelly McGarry, Dr. Jenna Georgiou, Dr. Daniel Walden and h/t James Crowley here: For family, for community, for their patients -- meet the new physicians going against the tide and staying in Rhode Island.
Residency Signaling Was Supposed to Help Medical Students. It May Be Hurting Them Instead (Matt Mazurek)
“Residency program signaling began with a reasonable idea. In practice, however, signaling risks creating another high-stakes strategic game for medical students already navigating one of the most stressful periods of their training.”
The Majority of U.S. Physicians Are Employed, and Their Commercial Negotiated Rates Exceed Those of Independent Physicians (Trilliant Health)
From Katie Patton, David Taylor, Jim Browne, Maura Eshleman and Allison Oakes: “In the Chicago market, blended commercial professional E/M rates for hospital-employed physicians average $239, compared with $147 for independent physicians, a difference of $92.”
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.
Great commentary, Chitra Akileswaran
Dr. Chitra Akileswaran opened up about the market for rural health doctors and why “We keep blaming doctors for abandoning rural America. The real problem is a market that was never built to let them stay.” Read more here.
Read her article, Shazia Siddique
Dr. Shazia Siddique wrote about why clinical decision support should build expertise, not replace it. “The best clinical AI tools I've used feel more like working with a brilliant medical librarian than a substitute attending.” Read more here.
Well deserved, Melvin Speisman
Dr. Melvin Speisman will be receiving the 2026 Laureate award from the Illinois Chapter of the American College of Physicians! Learn more and congratulate him here.
Important work, Daniel Clearfield
Responding to a post from Dr. Kirk Parsley about physician reimbursement, Dr. Daniel Clearfield started a cash-based sports & regenerative medicine practice, Motion is Medicine, and is now teaching others how to do this themselves. “If you are ready to take medicine back from the insurance companies, hospital organizations, and all of the other barriers between you and your patients, then reach out to me.” Connect with him here.
Very well said, Tyler Goldberg
Orthopedic surgeon Dr. Tyler Goldberg shared a spot-on post about why the physicians who thrive over the next decade won't simply work harder, “they'll understand how to design practice models that reward expertise, restore margin, and create long-term sustainability.” Read his commentary here.
Thanks for writing, independent physicians
Dr. Douglas Farrago wrote about Direct Primary Care and why it keeps hope alive for the next generation of doctors. Read it here. Dr. Jessica Kaiser Mendelsohn posted about quitting corporate medicine and opening her own practice: “My relationship with my patients is not a line item on someone else's P&L. It cannot be eliminated by memo.” Dutch Rojas spoke out about hospital facility fees and the ban on physicians owning hospitals here. Preston Alexander posted about how CMS is squeezing independent doctors: “Each year it becomes harder and harder for independent practices, leading to consolidation, rising costs, and declining access.”
Listen to the conversation, Haider Warraich
Dr. Haider Warraich spoke with Roy Perlis on the JAMA AI Podcast about the ADVOCATE Program high stakes AI technology to Americans with heart failure. Read more here.
Career news, congratulations to all!
Dr. David Eisenberg is now officially a psychiatrist! Congratulate him here. Dr. Scott Boden is transitioning to emeritus stats at Emory University School of Medicine. Dr. Vidya Puthenpura was featured in Westport Moms for her work as a pediatric hematologist and oncologist at Yale New Haven Children’s Hospital (h/t Dr. Vijay Yanamadala here). Ali Rafiq has been promoted to Adjunct Associate Professor at Kansas Health Science University!
And finally, well done Graham!
Graham spoke at the Australian Medical Association Conference about areas where AI could help physicians and why doctors need to speak up and decide how we expect AI to help ourselves and our patients. See his post here.
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