On/Offcall: Here's What Happened When She Quit Employed Medicine

Offcall Team

Welcome back to On/Offcall!

She walked away from her stable health system job with no plan. Now she’s building her own family medicine practice from scratch, and accidentally went viral telling the story.

On this week’s How I Doctor, Chloe Kindred gives Dr. Graham Walker an unfiltered look at what it actually takes to leave a health system and build an independent practice from scratch.

Chloe is a family physician in Central Florida who hit her breaking point in employed medicine. Her patient panel tripled almost overnight. Unpaid hours bled into her weekends. Then a “standardized” contract email suddenly rewrote her compensation plan. She was done.

This October, she opens Kindred Family Medicine, her own direct primary care practice. And after an unscripted Instagram rant she almost deleted hit 800,000+ views, she already has 230 people on her pre-enrollment list — more than double her year-one goal of 90. They cover:

→ The breaking point that finally made her leave employed medicine
→ The panic quit she rescinded within 12 hours — and why it became her dress rehearsal
→ How she priced her membership and sized a 300–400 patient panel
→ The surprisingly complicated mechanics of starting a practice from zero
→ Why she sees more DPC practices as validation, not competition

Plus, why Chloe believes the independent physician movement is “exploding” — and why so many PCPs are telling her they want to make the leap too.

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AI 202: How to Level Up Your Use of AI

You know how to use ChatGPT. Now what?

Join Offcall + Evidently for AI 202: How to Level Up Your Use of AI — a free live workshop for clinicians ready to go beyond basic prompting and start using the next generation of AI tools.

Graham and pediatrician + AI educator Dr. Michael Hobbs will get hands-on with the tools and workflows changing what clinicians can do with AI. We’ll cover:

👉 ChatGPT vs. Claude vs. Gemini: Which model should you actually use for what?
👉 AI agents: What they are, what they’re good at, and where the hype gets ahead of reality
👉 Skills vs. agents: When a human-configurable workflow may beat a fully automated one
👉 Beyond prompting: Custom tools and workflows that can do more than answer questions
👉 Don’t try this at home: PHI, patient safety, and what you shouldn’t hand over to AI

We'll also hear from Dr. Kai Romero who will share a live demo of Evidently’s newest approach to AI workflows, including its new Skills interface.

October 1 | 3pm PT / 6pm ET

RSVP here

Physician Spotlight: Meet Neal Kaushal

Have a response for Dr. Neal Kaushal? Reply to this post directly — he’ll personally read every message.

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. 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.

4. 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.

5. 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.

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

3 Things to Read This Week

AI-Based Translation of Discharge Instructions — Aligning Policy with Practice (NEJM)
From Mateo Rutherford, Elaine Khoong, and Melanie Molina: The case for a risk-based approach to AI translation of discharge instructions: one that gets validated translations into patients' hands in real time while keeping human expertise where it matters most. “Written instructions in a patient's own language shouldn't depend on the hour of the day. They should be built into how we practice.”

If DPC Is So Great, Why Isn't Everyone Doing It? (Metronome Family Medicine)
From Dr. Brian Juan: “Accidents happen. Cancer happens. Continuity doesn't prevent a car crash, and nothing makes catastrophic coverage optional. That isn't the argument. The argument is that much of what lands people in hospitals is preventable with access, time, and a physician who knows them — and we've built a system that reliably supplies none of the three.”

Medicine Is Messy. That Is Where the Art Lives. (MDCalc)
From Dr. Clay Dorenkamp: “The art of medicine should never become an excuse to ignore evidence. It is the work that remains after the evidence has been made as clear as possible. That is what good clinical AI looks like to me.” Also see Graham’s post here.

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.

Important work, Theodore "Jack" Iwashyna (h/t Rana Awdish here)
Dr. Theodore Iwashyna penned an NEJM Group Voices column reflecting on the ways in which Koritha Mitchell's concept of Know Your Place Aggression helps makes sense of a time a patient with sepsis was almost given the wrong care -- and what he should have done at that time. Read it here.

Sign up for the event, Columbus Medical Association
The Columbus Medical Association is hosting an Emerging Trends program about the use of AI in medicine in Central Ohio. Featuring an expert panel including: Dr. Andrew Narcelles, Dr. Laura Michelle Gravelin, Dr. Ravi Tripathi, and others. RSVP here.

Listen to the podcast, Fatih Gul
Dr. Fatih Mehmet Gul interviewed Dr. Suchi Saria for his podcast The Chief Healthcare Officer in an episode entitled, “Beyond the Hype: What Successful Healthcare AI Really Looks Like.” Listen to it here.

Also listen to the podcast, Stacey Richter
This week’s episode of The Relentless Health Value podcast hosted by Stacey Richter mentions Offcall’s recent viral story about hospital pricing in an episode entitled, “How Stark Law, Stipends, and Noncompetes Drive Hospital Consolidation.” Also featuring Dr. Eric Bricker. Listen here.

And one more podcast, Lee Scheinbart
Dr. Lee Scheinbart interviewed Korn Ferry’s Dr. Li Ern Chen about helping future physicians build leadership skills alongside their clinical training. Listen here.

Congratulations, Lois Lee
Dr. Lois Lee has been elected President-elect of the American Academy of Pediatrics! Congratulate her here.

More Career News, Congrats!
Dr. Rachel Nelson has been promoted as Director of Faculty Development for the Vanderbilt Department of Emergency Medicine. Congratulate her here. James Neal announced his oldest daughter received her white coat at Des Moines University School of Osteopathic Medicine (class of 2030). Ahmed Kazem began his career as an Interventional Cardiologist at Baylor Scott & White Health. Babatope Fatuyi stepped into the role of Chief Health Innovation Officer at UTHealth Houston. Congratulate him here. Aaron Neinstein is joining Counsel Health as Chief Growth Officer, congratulate him here. Zunairah Shah is starting her career as a Breast Medical Oncology faculty member at Roswell Park Comprehensive Cancer Center. Harris Helberg had his white coat ceremony with Darius Scott, congratulate them here.

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