On/Offcall: How AI Will Change Medicine

Welcome back to On/Offcall!

He’s built one of the most important AI companies for doctors…That’s valued at over 5 billion dollars…And he’s our next How I Doctor guest!

This week, Offcall’s co-founder Dr. Graham Walker sat down with Abridge founder and CEO Shiv Rao for our first ever (!) in person podcast interview about what it really takes to build AI that works for physicians. Abridge is at the epicenter of the AI revolution in healthcare. The company now works with over 200 health systems and powers over 1 million conversations weekly. But listen to Shiv’s vision for the future, and it’s clear this Pittsburgh-based cardiologist is just getting started.

Together, he and Graham unpack:

🧩 The founding story of Abridge and its ‘secret sauce’ for earning physician and health system trust
🔥 Why physicians feel stretched beyond their limits right now and how AI can be part of the solution
🤖 Why Abridge has never called itself an “AI scribe” and where Shiv wants the company to head next
🎨 How clinicians can keep our voice + creativity in a world where ambient AI becomes core healthcare infrastructure
🚀 What drives Shiv at the core and his lessons for other physician founders on how to win in healthcare

This is a raw, philosophical, and deeply human episode that we’re excited for you to enjoy either in audio or fully in video for the first time!

🎧 Watch or listen to the full episode on Offcall

Know someone who would benefit from joining us? Help us grow our tent by forwarding this newsletter to your physician colleagues and subscribing here.

Physicians, Tell Us How You Really Feel About AI

We’re gearing up for the release of our definitive physician AI whitepaper in December that will cover how physicians really feel about AI tools and their impact. The report will cover topics like: How AI could actually improve physician job satisfaction, which AI tools save us time vs. just add more admin burden, and how employers could get us excited to adopt new AI tools. 

Answer the short questions below (takes 2 mins!), and repost to spread the word! Huge thanks to physicians who have helped spread the word about the survey this week, including Dr. Ally Abel, Dr. Sarah Gebauer, Dr. Morgan Jeffries, Dr. Kaustav Paul, Dr. John Dayton, and many more!

How do you really feel about AI?

Exclusive! Q&A With Bill Heller, COO of CHG Healthcare

We recently had a chance to sit down with Bill Heller who is the COO of CHG Healthcare. If you’re not familiar with CHG, they are the nation's largest physician staffing company and they recently published a report called State of Locum Tenens 2025 offering a comprehensive look at the locums industry for physicians. Given all the interest we have seen from Offcall’s community around locums work, we wanted to talk with Bill about the key takeaways from the report and what they mean for physicians nationwide. Here are his responses, which are also published on Offcall here.

1. Bill, tell us about a few of your most important key conclusions from this year's State of Locum Tenens report. We’re really seeing a paradigm shift: Locum tenens is no longer just a temporary fix. It’s a core part of how health systems manage staffing, maintain care continuity, and reduce burnout. And utilization is growing — 80% of healthcare organizations plan to maintain or increase their use of locums next year. Actual usage in 2024 was 25% higher than anticipated. On top of that, physician interest is strong. One-third of U.S. physicians have worked locums. And those who do love the flexibility it affords them. Many use it to transition between roles, supplement income, or gain flexibility.

2. For physicians specifically who are dealing with burnout and downward salary pressure, what does the data show about why locums may be an attractive option? Burnout relief is a huge reason why physicians love working locums. 43% of physicians reported improved burnout symptoms, and many cited better work-life balance and more control over their schedules. They also love the financial flexibility. With inflation-adjusted physician earnings down 33% from a generation ago, locums offers a way to supplement income. 15% of physicians plan to use locums to increase earnings, and 48% of current locums physicians plan to increase their days worked. Career control is also a main reason why physicians love working locums — 29% of physicians choose locums to control their schedules and 10% explicitly to avoid overwork. Locums also supports career transition, whether between jobs, post-training, or pre-retirement. Local and flexible options are also cited as a massive benefit. Contrary to the myth of constant travel, 58% of locum physicians work what we call “local locums” in their area, and 53% in nearby regions.

3. What does the report show about what employers need to do in order to remain competitive as it relates to hiring and retaining their physician workforce? Embracing flexibility is key. Physicians increasingly expect autonomy, and employers should offer flexible scheduling, part-time roles, and telehealth options — areas where locums can help bridge gaps. HCOs also need to utilize locums strategically. Beyond backfilling, organizations are using locums to meet rising demand (35%), reduce staff workload (25%), and test new services (9%). They should also be investing in tech and efficiency. Tools like vendor management systems streamline locums onboarding and credentialing. 59% of organizations believe tech-enabled efficiencies will positively impact their contingent workforce. Organizations also need to expand support of advanced practice providers and telehealth. Demand for CRNAs is up 55%, and telehealth locums are gaining traction. Yet only 20% of physicians had access to telehealth locums roles, despite 47% expressing strong interest — highlighting an opportunity for forward-thinking systems.

4. For anyone interested in learning more about locums work and getting involved with CHG, where can they go to learn more? If you’re ready to jump in, I’d encourage you to reach out to the awesome teams at our staffing brands. Weatherby Healthcare has only locums positions, while CompHealth offers both locums and permanent options. If you want to learn more about locums life and learn more about the overall process, we’ve also got great resources at Locumstory.com.

Have a question for Bill or want to learn more? Email us at contact@offcall.com and we’ll connect you.

Physician Builder Spotlight: Louie Cai

We’re shining light on MD-entrepreneurs! Each week, we feature an entrepreneurial doctor who’s building a cool product, company, or working on a big idea that you definitely want to know about. This week, meet Louie Cai, Co Founder of Cosign AI, a start-up that is helping clinical trial sponsors and sites accelerate recruitment and close trials faster. You can connect further with Louie on LinkedIn.

1. Louie, what inspired you to become a physician entrepreneur? I’ve always had this underlying drive to make things better. During training and in clinical practice, I constantly noticed workflows and processes that were inefficient or just didn’t feel good for patients or clinicians. I could see what a better version could look like, and I kept thinking, “It doesn’t have to be this way.”A lot of healthcare innovation comes from people who have never actually practiced medicine. They’re smart, but they often miss the emotional and practical realities of what it feels like to care for patients day after day. I came to realize that the people who live the problems are the ones best positioned to solve them. If I wanted a tool that truly supported me and my colleagues — something empathetic, efficient, and clinically grounded — I had to be part of building it. If not me, then who?

2. Tell us what your company does and what problem you’re trying to solve. Our company is built around a simple mission: make healthcare cheaper, better, and easier to access. That mission came from a pretty honest observation — healthcare today is expensive, frustrating, and often hard to navigate for both patients and clinicians. We’ve experimented with different products in clinics, but our current focus — and where we’re seeing the strongest impact — is in clinical trial screening and recruitment. We take all the data that already exists in a patient’s chart and use AI to accurately match them to eligible clinical trials. Clinical trials have very clear inclusion and exclusion criteria, which makes this a great environment to build reliable medical decision support. This is our entry point into a much bigger roadmap. Over time, we want to build toward a physician copilot that enhances medical decision-making across the board. But today, we’re focused on solving clinical trial recruitment because it’s a meaningful problem, drives real value for practices and patients, and is a place where AI can genuinely make things better right now.

3. What’s your advice to anyone who’s thinking about entrepreneurship or a nontraditional career in medicine? You can’t do this for the money. Building something new in healthcare is incredibly hard. There are moments of real excitement when clinicians love what you’ve built — and then moments when investors tell you the idea is “too small” or “not disruptive enough.” The reality is that most meaningful healthcare innovation looks boring from the outside. Our daily work is mostly documentation, coordination, and administrative burden — so the tools that actually make a difference often don’t look flashy. They just quietly make clinical life better.

So my advice is: Don’t let the lack of hype discourage you. Don’t rely solely on investor interest as your validation. Instead, talk to other physicians. Talk to practices. Ask whether the problem you’re solving exists beyond your own personal workflow. Be genuinely curious about how others work — because the biggest trap is assuming your experience is universal. You will get rejected. A lot. By accelerators, by investors, by advisors. That’s normal. Use each rejection to refine, question, and re-evaluate. And if, after all that, you still deeply believe the problem matters — then keep going. The conviction to continue is the most important part.

4. How can a physician get over the “start” problem and overcome their biggest fear to start a company? The biggest thing is to just start talking to people. Conversations are massively undervalued. If you have an idea, use it as a reason to interview others:“I’m exploring a problem and would love your perspective — could we talk for a few minutes?” That’s your first step — not incorporating, building a prototype, or writing a business plan. It’s simply understanding whether the problem you care about exists beyond your own experience. You’ll find that almost every problem in healthcare is shared somewhere — and often there are already companies working on adjacent issues. That’s a good thing. It means the space is real. So do the research. Ask people about their workflows. Let curiosity drive the process before you commit serious time or money. Once you’re convinced the problem actually matters to others, that’s when you start building traction. Incorporation is just a logistics step — necessary only once you’re taking investment. Tools like Clerky make that part straightforward. And honestly, you can use ChatGPT to help outline your incorporation checklist and legal tasks — it’s great for that. But the most important piece: Find a co-founder. Building in healthcare is emotionally hard, slow, and often discouraging. You need someone to share the emotional weight with. There were many times I wanted to walk away — and my co-founder didn’t. And later, the roles reversed. Having someone to pull you forward when you’re doubting yourself is everything. 

So in short: 1. Talk to people and validate the problem first. 2. Don’t rush to incorporate; that’s just execution. 3. Find a co-founder to share the journey — and the setbacks.

5. What’s the #1 lesson you’ve learned since building your company that wasn’t obvious to you before? The biggest lesson I’ve learned is that everything takes longer and is more complicated than you expect. An idea might seem simple in your head — “we’ll talk to a few people, run a pilot, and launch quickly” — but execution is almost always harder. Things that feel like they should be fast often end up taking ten times longer and being ten times more complicated.

The key is to keep moving forward, even if it’s just small steps. You might not scale from 1 to 100 in a month, but going from 1 to 2, or 2 to 5, still counts. Healthcare innovation is slow, and headlines of companies raising millions in a few months often hide years of behind-the-scenes work. Don’t get discouraged if you haven’t raised enough money or gained huge traction yet. Steady progress is what counts.

6. What are your top resources that helped on your entrepreneurial journey? There are three resources that have been incredibly helpful: 

1. Alchemist Accelerator – I never went to business school, so a lot of the basics of building a company were new to me. Being part of a formal accelerator gave me a structured curriculum and a roadmap for the steps I needed to take. It also connected me to a network of founders and advisors outside of medicine, which helped me realize that the problems we face in healthcare are not unique — they’re challenges every startup encounters.

2. YouTube – There’s an enormous library of videos where founders share their experiences at every stage of building a company. I’ve learned a lot from YC talks and founder interviews. Not every lesson applies directly to healthcare, but listening to how other founders approached go-to-market strategies, product development, and fundraising has been invaluable.

3. ChatGPT – This has been a game-changer. It’s an amazing way to get a foothold in areas you’re unfamiliar with, whether that’s marketing, sales strategy, product design, or legal questions. ChatGPT allows you to quickly understand the basics so you can have informed conversations and make decisions with confidence. It dramatically lowers the barrier to doing something completely new.

7. How can other physicians support you? Right now, our focus is clinical trial recruitment, and this year we’re looking to work with sites that run a high volume of trials to help improve their workflows. Our product is currently free for sites to use, and we’d love to collaborate with anyone interested in accelerating clinical trial recruitment, particularly in ophthalmology, pain medicine, rheumatology, and dermatology. We’re also open to conversations with potential investors who are interested in the clinical trial space and exploring opportunities for collaboration. If you’d like to connect, the best way to reach us is via email at louie@co-sign.ai or through our website/contact form.

Bonus! 3 Questions About How Louie Uses AI

Just for Offcall members: We're making available Louie’s answers to 3 questions about AI: 1) What's an actual prompt you're feeding to GPT that's been helpful to your clinical work? 2) What's the AI tool/use case you can't live without? 3) What are your top AI resources to get going as a physician?

Read Louie’s answers and sign up for Offcall here. Know someone else who should be featured? Reply or tag them and their company in the comments!

Best Things to Read This Week

The future of hospital care is in your living room (Becker’s Hospital Review)
From Robert C. Garrett, CEO of Hackensack Meridian Health: “Congress must step up once again and approve an extension to the waiver so that hospitals can continue to launch and expand this winning breakthrough.” (h/t Dr. Pamela Saengar here)

Primary Care Physician Time Spent in Patient Care (Annals of Internal Medicine)
An observational study using EHR logs, from: Dr. Lisa Rotenstein, Dr. Michelle L’Heureux, Dr. John Fangman, Dr. Moshe Rancier, Dr. Richard Gitomer, Dr. David W. Bates, Dr. Bruce Landon, and others.

Pay Gap Between Nonprofit Hospital CEOs And Employees Grew (Health Affairs)
Using Form 990s and Medicare cost reports to examine trends in wages and wage inequalities within nonprofit hospitals and assess differences by hospital characteristics, from: Cal Chengqi Fang, Sabrina D. Wang, Jonathan Cantor, Christopher M. Whaley, Brian Briscombe, and Joseph Dov Bruch.

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, Gary Price
Dr. Gary Price, president of The Physicians Foundation, recently released a report showing how the erosion of physician autonomy is harming patient care and accelerating workforce losses. Read it here.

🎧 Give it a listen, Ali Rahimi
Dr. Ali Rahimi, founder of ALYKA Health (and previous Offcall guest!) appeared on Yale Insights’ Health & Veritas podcast alongside Howard Forman and Harlan Krumholz to discuss his efforts to help patients maintain positive momentum between cardiologist visits, through engagement, data, and feedback. Give it a listen here.

🎧Also give it a listen, Eve Cunningham
Dr. Eve Cunningham, Chief Medical Officer of Cadence, joined Dr. Craig Joseph, CMO of Nordic Global, on the Designing for Health podcast to discuss her lessons learned about what actually works in healthcare technology. Give it a listen here.

🎉 Fantastic news, Cara Poland!
Dr. Cara Poland has been awarded this year’s Betty Ford Award from AMERSA recognizing work advancing substance use education in medical training. Bravo. Congratulate her here.

✅ Well done, Ujjwal Ramtekkar
Dr. Ujjwal Ramtekkar is joining the Clinical Advisory Board at Cylinder Health to contribute to “this next chapter of whole-person digestive care.” Learn more here.

🎉 Congrats, David Meguerdichian
Dr. David Meguerdichian recently began a new chapter at Lahey Hospital & Medical Center and the UMass Chan School of Medicine. Learn more and congratulate him here!

Be Sure to Sign Up for Offcall!

At Offcall, we believe physicians deserve to be heard, valued, and treated fairly. Everything we do is driven by our commitment to empowering doctors with accurate, reliable, and trustworthy data — to advocate confidently for themselves and ensure their compensation truly reflects their worth.

Learn more and sign up here

Did Someone Share On/Offcall With You?

Thanks for reading. Each week, we bring the latest news, information, financial and career tips, and dose of inspiration to your inbox. Our community is growing fast! Join us by subscribing to this newsletter. And please be sure to forward this newsletter to your colleagues and friends. Thank you!

Subscribe