On/Offcall: The Physician's Guide to AI Free E-Book Is Here!
Announcing: Our #1 Best-Selling E-Book!
BIG NEWS ‼️This week, we’re proud to announce the release of The Physician's Guide to AI: A Practical Primer Across Specialties, a brand new e-book published by Offcall and MD+.
Developed by 40+ authors and editors, we created this book to meet a real and growing need: As AI reshapes clinical medicine at every level, physicians across all stages of training deserve a clear, specialty-specific foundation for understanding it. We cover 9 specialties in depth, from internal medicine and emergency medicine to oncology, surgery, and beyond. Each chapter offers practical, evidence-informed insight into how AI is changing the way we practice.
Whether you’re an attending navigating new clinical tools, a resident integrating AI into your training, or a medical student building your foundation, this book is for you.
And the best part? It's completely free to download.
Introducing: Open Tabs With Dr. Michael Hobbs
🎉 We’re thrilled to announce the kickoff of our newest series: Open Tabs with Dr. Michael Hobbs.
In each episode, Michael will explore a different AI tool, showcase how he's using it as part of his clinician workflow, and offer practical tips, hacks, and tricks others can also use in day-to-day practice. First up: See how Michael 10x’d his use of Claude! Whether you’re just getting started or already have 37 AI tabs open 👀, this series is for you.
Watch the first episode of Open Tabs here
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The New Yorker’s Dr. Dhruv Khullar on Medical Authority in the Age of AI
This week on How I Doctor, we welcomed Dr. Dhruv Khullar, a hospitalist, health policy researcher, and contributing writer to The New Yorker, where he spends months reporting in-depth stories about what medicine is becoming.
Dhruv is thoughtful, clear-eyed, and unafraid to say what many physicians sense but can't quite articulate: That the authority doctors once held now has to be earned, and that the system is making it harder to practice every day. Together with Dr. Graham Walker, they dive into:
✨ Why your patient may already trust ChatGPT more than they trust doctors
✨ A jaw-dropping AI demonstration that nearly made Dhruv gasp in the room
✨ How Medicare Advantage turned risk adjustment into a revenue extraction game
✨ Whether medicine has become just a job, and what it would take to make it a calling again
👀 If you've ever felt like the ground is shifting under medicine but couldn't name exactly why, this conversation will help you find the words.
Physician Spotlight: Meet Dr. Nicholas Melucci
1. Nicholas, what's one task you've fully handed off to AI that you'd never take back? Two, and they live on opposite ends of my day: On the non-clinical side, it's the scaffolding of anything long-form or open-ended. Big writing projects, planning out my fellowship search, even outlining research ideas and figuring out which ones are worth chasing. It's turned projects I'd have abandoned into things I actually finished.
Clinically, it's first-pass clinical questions on shift. I'll use something like Doximity Ask to quickly get oriented on a dosing question, an interaction, a workup nuance I half-remember, the kind of thing I'd otherwise burn ten minutes chasing.
2. Are you worried about deskilling — that the next generation won't develop the intuition you did because the model handled it? Yes and no. I'm less worried about AI handling the task than about it handling the learning/reasoning behind information. A lot of EM intuition is built in the moments where you're uncomfortable, uncertain, and forced to commit anyway. If a tool smooths that over before an intern ever sits in the discomfort, they don't get the reps. That said, every generation says this. My attendings learned certain skills that are already obsolete with technologies created before I started residency. My real worry is subtler: that we'll lose the ability to catch AI hallucinations when they’re confidently wrong, because you only catch these answers if you know the answer well yourself.
3. If you could redesign residency from scratch, what's the first thing you'd change? I'd treat the schedule as the safety issue it is rather than a rite of passage. The hardest parts of residency teach us despite the exhaustion, and I don't think the brutality itself is what makes us good.
I come at this from an athletics background, which is part of why it stands out to me. Sport learned decades ago that planned recovery and focused, varied reps outperform constant maximal effort. Elite performance isn't built by grinding athletes into the ground every day. It's built on periodization, deliberate recovery, sleep, and attention to the mental side of performance. We have a real science of how to sustain high performance in a human being, and I'd love to see us apply more of it to the people we ask to make life-and-death decisions at hour twenty.
What draws me to this isn't a critique of the people who trained before me. They did extraordinary work under the rules they were given, and I have enormous respect for it. It's that the evidence on sleep, error rates, and burnout has matured a lot, and I think the next iteration of training can fold that evidence in without losing the rigor that makes EM what it is. Society applies this same evidence to numerous high performance fields. I'd like us to extend a little more of it to ourselves, in a way that keeps us sharp for the full length of a career rather than just the length of a residency.
4. What's something physicians are quietly worried about that the public doesn't know about yet? How much of a broken social contract emergency medicine is quietly holding together, and how close that's getting to its limit.
The public sees a busy ER and assumes the system is straining but holding. What we see is that boarding, meaning admitted patients with nowhere to go, has gone from the exception to the norm. We've become the pressure-release valve for a system running over capacity for years, absorbing every failure that happens upstream and downstream of us.
That strain is starting to surface publicly, including the violence against staff that has become a routine part of the shift, and shows like The Pitt are putting it in front of people. But it raises a question I think we owe ourselves across every generation in this field. We come from a tradition of sacrifice, and that ethic is one of the best things about medicine. The danger is when sacrifice becomes the system's plan rather than the exception. The answer isn't to care less; it's to stop building a system that depends on our selflessness to keep it standing, especially as a wave of physicians near retirement and others leave the field far earlier than they intended. The demand on the backstop keeps climbing while the number of people able to be that backstop shrinks. How do we honor what this profession has always stood for while building something the next generation can sustain?
Read the full-length version here. Know someone else who should be featured? Reply or tag them and their company in the comments!
4 Things to Read This Week
We broke down what The Pitt cast would ACTUALLY make IRL… by the hour (Offcall)
Do better. 🩺💸
Hundreds of Clinicians Unionize at Banner Health (MedPage Today)
Also see Graham’s interview on physician unionization with Dr. Sean Codier here.
How One DPC Doc Got a Head Start on Building His Practice (AAFP)
Dr. Brad Brown started his own DPC during residency — 15 months before graduation. Here’s how he did it.
Why Your Hospital Pays $1,000/Hour for a $350/Hour Doctor (Marc Ayoub)
A board-certified physician agrees to a weekend rate of $350/hr. The hospital gets billed $1,000/hr. The middleman pockets a $650 spread just for moving a phone number across town.
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
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.
Fascinating data, Sina Hartung
Sina Hartung shared data showing self-employed physicians out-earn employed doctors by 11 percent, roughly $391,000 versus $353,000. See that data here!
Give it a read, Barry Breaux (h/t I. Obi Emeruwa here)
Dr. Barry Breaux wrote a heartfelt essay entitled “Why I Left, and What I’m Building Instead,” about his experience pivoting from academia and what he sees as wrong with our current health system. Read more here.
Give it a listen, Kim Downey and Eva Minkoff
"Most doctors were never taught how to sit with a patient’s grief, anger, or fear without absorbing it.” Health care executive coach Eva Minkoff and physician advocate Kim Downey joined Dr. Kevin Pho to discuss their new article “'How regulating clinical empathy prevents physician burnout.” Listen here.
Congratulations, Nelson Malone
Dr. Nelson Malone has officially graduated from the Johns Hopkins Emergency Medicine Residency!! Congratulate him here.
Also congratulations, Brian Kim
Physician-scientist Dr. Brian Kim announced he will be joining The Feinstein Institutes & Northwell Health as the inaugural Chief Biotechnology Officer. Read more here.
More career updates, Ronen Rozenblum, Rohan Khazanchi, and Harman Chopra
Dr. Ronen Rozenblum announced he has been promoted to Associate Professor of Medicine at Harvard Medical School. Congratulate him here. Dr. Rohan Khazanchi wrapped up his final shift of Med-Peds residency training at Brigham and Women's Hospital, Boston Children's Hospital, and Boston Medical Center (BMC). Congratulate him here! Dr. Harman Chopra finished his Pain Medicine fellowship having trained at Weill Cornell Medicine, Hospital for Special Surgery, and Memorial Sloan Kettering Cancer Center. Congratulate him here.
Read her book, Grace Torres Hodges
Dr. Grace Torres Hodges wrote a new book, “Doctor Do, Don’t Don’t” to help future physicians think critically about the kind of doctor they want to become, the type of practice they want to build, and the values they refuse to compromise. Read more and download the book here!
Sad but true, Kanwar Kelley and Shiv Patel
Dr. Kanwar Kelley sparked a big conversation by pointing out the sad math of current reimbursement rules: A surgeon coming in at 2am to perform emergency brain surgery would get paid MORE if they skipped billing for the operation and just billed for the postoperative care instead. Read it here. Also see Shiv Patel’s post about how we value orthopedic surgeons here.
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