On/Offcall: Billion Dollar Physician Founder Shares His #1 Lesson

Offcall Team

Welcome back to On/Offcall!

Dr. David Lortscher built a company worth over $1 billion, and learned one surprising lesson along the way… This week on How I Doctor, Offcall co-founder Dr. Graham Walker sat down with David, who left a dermatopathology fellowship at UCLA to found Curology, one of the first companies to combine telehealth, compounded prescription skincare, and a subscription business model.

After a decade as CEO, he recently stepped back and wrote a powerful book "Why Doctors Win" (co-sign!) in which he found that 51 of the top 100 healthcare companies founded since 1985 have one thing in common: A physician founder!

👀 The episode is a powerful reminder that the people closest to the problems are often the ones best equipped to solve them. They discuss:

✨ Why physician founders outperform by roughly 3x
✨ Why pairing a doctor with an engineer is the "killer combination" behind top health tech companies like Abridge and Viz.ai
✨ The #1 blind spot doctors have as founders
✨ His advice for any physician sitting on their own version of a founder's dilemma

Listen to the episode here

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Getting the Most Out of AI As a Clinician

Thanks to everyone who joined this week’s AI webinar: How to Get the Most Out of AI as a Clinician! More than 300 clinicians registered, and the discussion in the live chat was one of the most active we've ever seen. Seeing physicians share ideas, answer questions, and build together is exactly what we hoped this series would inspire.

A HUGE shoutout to our incredible hosts: Dr. Michael Hobbs, Dr. Graham Walker, Dr. Thomas Kelly (Heidi CEO), and Dr. Liam McCoy (Science Communications Lead at ARISE). And to our sponsors Evidently, Heidi, and InnovatorMD for supporting this series.

In case you missed it, you can watch the full recording and get all of the slides here.

Physician Spotlight: Meet Dr. Sylvie Stacy

Have a response for Dr. Stacy? 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!

1. Stacy, do you think AI will solve the physician shortage or quietly make it worse? I don’t think it’s going to solve it or make it worse. It might help the situation, but that depends heavily on how well our healthcare system can adapt to AI’s capabilities. A lot of aspects need to adapt: clinical guidelines and protocols, EHRs, insurance coverage policies, state licensing bodies, etc.

2. If you could redesign residency from scratch, what's the first thing you'd change? When I was in training, one frustration I had was watching attendings run on fumes all the time. Some were so buried in work and had such a high patient volume that it was hard for them to dedicate time to teaching interns and residents. I felt bad sometimes for asking a simple question…like I was just putting another burden on them. A resident shouldn’t feel like an inconvenience just for trying to learn.

3. Independent practice in 2026 — endangered species or quiet comeback? Private practice as we knew it during its golden age in the 1980s may be an endangered species. But what’s taking its place, to some extent, seems to be reimagined private practices – especially those that strive to remove any sort of ‘middleman.’ Like micro-practices, direct primary care, and certain telemedicine models allow physicians to really focus on treating patients, and less on administrative and operational issues.

4. What's something you used to judge other physicians for that you now completely understand? I remember I used to get frustrated with my own doctors when they didn’t remember what their plan for me was at my prior visit. Now I totally understand that’s nearly impossible with a large panel of patients. I definitely have memorable patients whose details I remember from visit to visit. For most, though, I rely heavily on my notes and try to take a couple minutes before the visit to refresh my memory.

5. What did you spend money on early in your career that absolutely wasn't worth it? Getting a lawyer to review my employment contract. He focused on minutiae that didn’t actually matter. And he missed a couple things that, in retrospect, I would have changed if I’d taken the time to fully review and understand the contract myself. So I figured out early on that I wanted to be familiar enough with employment contracts and contractor agreements to be able to digest and negotiate them myself. Also, if you’re like me and do side work and consulting on top of regular employment, you’ll come across a lot of these contracts, so it’s a good skill to have.

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.

Read the full-length version here. Know someone else who should be featured? Reply or tag them and their company in the comments!

What 40 Future Clinicians Want You to Know About AI

This week, we’re highlighting Dr. Gigi Magan, a family physician and co-founder of Alma First, a 501(c)(3) focused on health equity in medicine. In February, Alma First convened a listening dinner and paired it with a survey of 40 respondents, from pre-health undergraduates to residents.

Their goal? To understand what the next generation of physicians think about AI, are being taught during training, and identifying what gaps currently exist. Among their key findings for practicing physicians, they found that:

AI is already inside training. 77.5% of respondents use it at least weekly. 30% use it daily. Yet 30% report no formal training in statistics, informatics, or AI.
The verification gap is forming now. 25% always verify a confident AI answer. The rest verify sometimes, rarely, or never. One pediatrician ran the same gray-area case through two tools. One output read like an emergency. The other said wait. Her conclusion: information is cheap now. Knowing whether to trust it is the expensive part.
They want the education physicians keep saying they need. Their top requested topic was recognizing bias, errors, and safety risks, at 72.5%. Then using AI without undermining clinical judgment, at 60%. In the AMA's 2026 survey, 88% of practicing physicians worry about trainee skill loss. Both generations agree on the problem. Neither has a plan.

“The habits they form during flashcards at 11 pm become clinical habits. If you teach, precept, or supervise anyone earlier in training, ask one question this week: what are they doing with AI that you haven't asked about yet? The answer is more than you think. It was for us,” said Magan.

Read the full essay, with the complete list of findings, and subscribe to Dr. Magan’s Substack here.

2025 PHYSICIANS AI REPORT

Access the Complete Report

✓Complete quantitative breakdown of what physicians really think about AI

✓Strategic implications for healthcare organizations and AI companies

✓Sentiment analysis of physician attitudes about AI and the future

Download full report

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.

Give it a watch, Pierre Elias
Dr. Pierre Elias appeared on CBS Mornings to discuss AI in medicine, Pathway Labs, and how we should think about these technologies. Give it a watch here.

Give it a read, Sanjay Basu
Dr. Sanjay Basu shared a new peer-reviewed study on safer, auditable clinical AI this week on an important topic, asking which clinical safety rules can be assured by proof rather than by sampling. Read more from him and co-authors Parth Sheth, John Morgan, Rajaie Batniji, and Bhairavi Muralidharan here.

Also give it a read, Narges Razavian
Narges Razavian published an article laying out important bureaucratic obstacles with national HealthAI policies, that hamper innovation and much-needed patient impact. Alongside co-authors Prem Batchu-Green, Vikas Chowdhry, Olivier Elemento, Pranav Rajpurkar, Suchi Saria, Nigam H. Shah, and Eric J. Topol, they proposed a few concrete and practical solutions grounded in expertise, experience, and first principle thinking. Read more here.

Way to go, Hardeep Phull
Dr. Hardeep Phull published an op-ed “Getting AI to Stick to Our Hippocratic Oath,” looking at a new study called NOHARM that analyzes how safe is the medical advice that AI gives and is one the safest? Read it here.

Well done, Heidi and DiME
This week, Heidi announced its participation in the Digital Medicine Society's (DiMe) new initiative, Operationalizing AI Governance to put AI governance principles into practice across procurement, contracting, implementation, and deployment. Learn more from Heidi’s North America President Jessie Young and DiME’s Associate Program Director Ian Miller here.

Eye-popping numbers, Michael Meneghini, Bill Byungyol Chun, and Preston Alexander
Dr. Michael Meneghini shared an eye-opening post in response to CMS’s Physician Fee Schedule proposed rule: “$980... That's what Medicare will pay a surgeon to replace a human hip in 2027. A set of four car tires costs about the same. CMS just proposed the largest single-year cut to hip and knee reimbursement in history. 20%. Let that sink in.” Read it here. For more on the topic, also read Dr. Bill Byungyol Chun’s eye-opening post: “$677. That is what Medicaid paid me for a robot-assisted laparoscopic total hysterectomy with bilateral salpingectomy. Let me tell you what that number is buying. Twelve years of training - four of college, four of medical school, four of residency. Then years beyond that mastering robotic technique, because this procedure is not something you learn in a weekend course. Only a handful of surgeons in my generation perform it at volume.” Read it here. Also read Preston Alexander’s reflections on the topic and join his effort to submit comments to CMS and push back here.

Well said, Daniel Wandsneider
Dr. Daniel Wandsneider posted a heartfelt essay about what consolidation in medicine actually means for physicians: “Nearly 8 in 10 physicians are now employed by hospitals or corporate entities. A generation ago, that number was flipped. Everyone treats this like progress. Consolidation, scale, efficiency. Here's what I've watched actually happen... The person deciding how medicine gets practiced moved further and further from the bedside. Staffing decisions made by a spreadsheet three states away. Doctors becoming line items.” Read it here.

P.S. Thanks to everyone in Columbus who showed up for our first ever Offcall Connect event! Reply back if you want to host one in your city.

P.P.S In honor of ‘The Pitt’’s 25 Emmy nominations, please enjoy some of our favorite scenes turned into healthcare memes 😂

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