On/Offcall: The New Playbook for Practicing Medicine Today

Welcome back to On/Offcall!

The playbook for practicing medicine has changed.

Don’t broadcast your opinion. Stay off social media. Put your head down and "just do medicine." —> That was the old way of practicing.

But today, as misinformation and public health skepticism spread like wildfire —> Physicians need a new way of practicing.

At least that was the message this week from Shoshana Ungerleider, who talked with Offcall co-founder Dr. Graham Walker on How I Doctor about why it’s time for more physicians to start speaking out in the public arena. Shoshana is an internal medicine physician, the host of TED Health, and the founder of End Well. She's spent her career mastering the skill of communication for both her patients and in public, and she thinks physicians need to:

👉 Learn how to communicate better with distrusting patients
👉 Start podcasts to shine light on what's really happening in medicine
👉 Use social media to educate fellow physicians and the public
👉 Do advocacy work for important policy causes

That may still feel foreign or even uncomfortable for many physicians, but according to Shoshana, it's the only way to start rebuilding trust...not to mention, in a world of AI everything, it's exactly the art of human connection that cannot be replaced.

Thanks Shoshana for leading the way. ❤️

Listen to the full episode

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Most Talked About On Offcall

From Calling to Career: Why Setting Boundaries Is Essential for Physician Sustainability

Hot off the press from Dr. Garrett J. Terracciano: “The very qualities that make us good doctors — our dedication, our willingness to sacrifice, our sense of calling — are slowly killing us. It's time for medicine to confront an uncomfortable truth.”

How I Use AI as a Physician: Dr. Ahmad Saab

Our new series: Here's how I'm using AI as a physician today, featuring Dr. Ahmad Saab. Interested in being featured? Let us know (contact@offcall.com)!

Data Reveals the Gender Pay Gap in Emergency Medicine

ICYMI, our new data shows EM women physicians earn significantly less than men despite working the same number of hours. (Bonus on this topic: JUNE Partners recently announced a collaboration for pay equity and workforce strategy in academic medicine with Dr. Amy Gottlieb. Learn more here (h/t Dr. Resa Lewiss, author of “MicroSkills”)

Independent Physician Spotlight: Christian Monsalve

New feature! We put out a call to celebrate independent physicians and the response was incredible. So we’re featuring a doctor who’s decided to go (or remain!) independent despite all the odds to restore their autonomy and provide better patient care. This week, meet Christian Monsalve, who’s the founder and medical director of his own practice Verigrate Health. You can connect further with Christian on LinkedIn.

1. Christian, give us a little background on you and your practice. I was a philosophy major who discerned a vocation to medicine, in part, due to the study of bioethics. During residency, I founded Verigrate Health, which offers functional psychiatry and psychotherapy for adults and adolescents seeking root-cause treatments for anxiety, ADHD, depression, and compulsive behaviors. All patients receive comprehensive lab testing that informs judicious treatment selection including psychotherapy, exercise, nutrition, supplements, and pharmacotherapy (when appropriate). For some patients, this involves helping them taper off medications in order to minimize dependency. We currently serves patients across California, Florida, New Jersey, New York, and Texas via telemedicine in English and Spanish.

2. What do you see as the biggest challenges to physicians going (or staying) independent? The economic requirements. It is difficult to decline a full-time employed position with guaranteed compensation right out of training when the alternative of starting and maintaining a new medical practice involves significant time and effort. Many young physicians carry substantial financial obligations that might disincentivize them from building on their own. Fortunately, I've been able to mentor every medical student and trainee who has contacted me regarding independent practice. In order to build my practice, I worked extra moonlighting shifts for several years during residency in order to save up for the startup and licensing costs. Every decision regarding the growth of the practice is intentional in order to expand clinical services across the country at a sustainable pace that maintains the mission of clinical excellence, alleviation of suffering, and respect for human dignity.

3. What are the biggest benefits for going independent? You can practice how, in good conscience, you want to practice. You are able to spend more time with each individual patient. In addition, you free up time for other rewarding duties such as family and serving where there is a need. For me, some of that involves volunteering for Spanish-speaking immigrants, expectant mothers, and religious organizations.

4. What's your advice to anyone who's thinking about making the leap or deciding what path to take straight out of training? Moonlight and save funds for your practice. Apply for multiple state licenses (if you plan to offer services in multiple states) several months prior to completing training. Create a private practice elective in your training program and invite physicians from across the country to speak virtually on how they successfully built their practices. My colleagues and I were able to learn from dozens of successful individuals who had already taken that leap. You'll be surprised at the generosity of others in mentoring young physicians.

5. Are there any resources you can recommend to help physicians who are considering this path? There are too many to list. Some include DPC Frontier, Association of American Physicians and Surgeons, Dr. Philip Eskew, and Dr. Josh Umbehr among many others. During your commute, you can listen to additional free resources such as the podcast White Coat Investor or the YouTube channel HealthPreneur.

6. How can other physicians who are inspired support you? First, I'm happy to mentor (for free, of course) physicians in training who are considering independent practice. Should colleagues determine Verigrate Health is a good fit for collaborating on care for their patients, they are welcome to visit https://www.verigrate.com, set up a meeting, or email contact@verigrate.com.

This excerpt has been shortened, read the full article here. Know someone else who should be featured? Reply or tag them and their company in the comments!

Best Things to Read This Week

Big Story of the Week #1: OpenAI’s GPT-5 announcement took over our feeds this week. Rounding up a few thoughtful reflections (send us yours!): Dr. Umair Khan, Dr. Ethan Goh, Dr. Roxana Daneshjou, and Graham.

Other Big Story of the Week #2: Epic is expected to announce its own ambient scribe later this month. Reflections from Dr. Joshua Liu here (also send us yours!).

Can AI Draft Discharge Summaries As Well As Hospitalists?(Medscape)
New paper from Dr. Charumathi Raghu Subramanian, Dr. Ben Rosner, and Dr. Chris Williams: Comparing hospital discharge summaries created by hospitalists with those drafted by LLMs.

The Worrisome State of Independent Practice (Medical Economics)
Interview with Paul Berggreen: Physicians are fighting market conditions that make it difficult for them to stay in business.

Texas Surgeon Says UnitedHealthcare Dispute May Force Her Into Bankruptcy (NBC News)
Bankruptcy could loom for Dr. Elizabeth Potter if the insurance giant doesn't accept her clinic. Learn more about her case from her excellent Offcall podcast with Graham here.

From Our Partners: Join the XPC Hackathon!

Cool opportunity alert! X = Primary Care is hosting a virtual hackathon to showcase ideas to transform clinical workflows! Software engineers, clinicians, product and ops leaders, founders, and curious builders should apply!

🗓 Aug 29-31, 2025
💰 $1,000+ in prizes
What you’ll get:

- Hands-on EMR sandbox with APIs & SDKs
- Rich longitudinal patient data
- Dedicated mentorship from physicians, senior engineers & product leaders
- Cutting-edge AI access (LLMs, clinical-insight engines, healthcare APIs)

Learn more and get in touch with Dr. Paulius Mui here!

Highlights From Our Community

Each week, we celebrate career milestones, launches, & other goings-on in the physician community. Have something to promote? Let us know (contact@offcall.com)

📖 Stop and go read it, Diane Shannon
Massachusetts Medical Society shared Dr. Diane Shannon’s thoughts about her 30 year journey to discover what makes a sustainable career for clinicians. “These lessons came too late to save my clinical career but they could save yours.” Read more here.

✅ Thanks for sharing, Cara Poland
Dr. Cara Poland penned an eloquent essay about learning to say no in a medical system that always asks physicians for more, more, more. Read it here.

🎙️ Great podcast listen, Romie Mushtaq
Dr. Romie Mushtaq appeared on Amna Shabbir’s podcast “Success Reimagined” to discuss why leadership in 2025 demands presence over perfection, a big shift for high-achieving physicians. Listen and learn more here.

🎉 Bravo, Gina Siddiqui
Dr. Gina Siddiqui is starting a new position on the Advisory Board at The Alliance for Longevity Initiatives. Well done! Congratulate her here.

🏆 Keep it up, Simon Chang!
Dr. Simon Chang, founder of the e-prescribing start up eNavvi, spoke with Dr. Terence Tan about navigating an alternative career as a doctor. Read it here.

🥳 Very nice, Gita Pensa
Dr. Gita Pensa was featured in Brown’s Alumni Magazine for her Emmy-nominated series “A World of Hurt: How Medical Malpractice Fails Everyone.” Check it out here!

❗Important work, Quinn Wang
Dr. Quinn Wang published an important Stark Law compliance guide for independent surgeons as part of her new company Doctors In Network. Read it here.

🤔 Insightful post, Wayne Gillis
Healthcare leader Wayne Gillis asked 5 young physicians what they fear most, and the answers were both illuminating and insightful. Read it here.

🎊 Congratulations, Andrew Gerber!
Dr. Andrew Gerber is starting a new position as President Elect at Connecticut Psychiatric Society Inc. Wish him congratulations and connect further here.

🙏 Thanks for your work, Yang Wang
Alongside colleagues Jared Perkins, Christopher Whaley and Ge Bai, health economist Yang Wang released a new study finding that a growing number of urban hospitals obtained dual classification as both urban and rural so they could use the higher urban wage index for Medicare reimbursements. Read more here.

🎊 Also congratulations, Michael Knight
Dr. Michael Knight was elected Chairperson of the Board of Trustees for the National Medical Association, the nation's oldest organization representing African American physicians and patients. Congratulate him here!

🎊 🎊 Also also congratulations, Kyle Kunze
Dr. Kyle Kunze is starting a new position as Sports Medicine and Shoulder Surgery Fellow at Midwest Orthopaedics at Rush. Congratulate him here!

🙌 Amazing work, Camille Clare
Dr. Camille Clare was named President Elect of the American College of Obstetricians and Gynecologists. Congratulations! Learn more here.

🩺 And finally, very well said, Graham
Graham reflected on a recent clinical incident in which he relied on his gut despite all the signs pointing to an alternative diagnosis and was able to send his patient home from the ER just a few hours later. A powerful reminder about the importance of human physicians in the AI in medicine era! Read it 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

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