On/Offcall: Why Practicing Medicine As a Career Is Making a Comeback!
Welcome back to On/Offcall!
What if an AI tool saves lives — and doctors still hate using it? A model might meaningfully improve outcomes but the physician experiences every extra alert, every false positive, while rarely knowing when the technology actually prevented something terrible from happening.
This week’s How I Doctor guest Dr. Karandeep Singh knows the problem firsthand. Karandeep’s research famously scrutinized Epic's widely deployed sepsis prediction model, finding a major gap between how the model was supposed to work and how it performed in the real world. Today, he's the inaugural Chief Health AI Officer at UC San Diego Health, helping decide how AI should actually be deployed in clinical care. He talks with Dr. Graham Walker about:
→ Why physicians can love generative AI while resisting predictive AI that may actually improve outcomes
→ What his research into Epic's sepsis model taught him about evaluating AI in the real world
→ How UCSD is using agentic AI to automate administrative work without removing clinicians from the loop
→ Why deploying AI safely requires understanding not just whether it works, but how it fails
→ Why he believes medicine needs regulatory sandboxes to test forms of AI-enabled care that aren't even legal today
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On/Offcall is the weekly dose of information and inspiration that every physician needs.
Make Sure Physicians Get Represented at SXSW!
AI is making it possible to build healthcare technology faster than ever. But as the barriers disappear, the bigger question becomes: Who decides what actually gets built? We believe that should start with physicians. Our co-founder Dr. Graham Walker is up for a panel spot at SXSW 2027 alongside Heidi's Dr Simon Kos for a conversation on “Who Builds Health Tech When AI Writes the Code?”
Help us bring that perspective — and the Offcall physician community — to Austin by voting for the panel here.
Most Talked About On Offcall
Does America have a cortisone problem?
From Dr. Nikhil Verma M.D., founder of Essential Sports & Spine Solutions: Physicians are reaching for corticosteroids too quickly — here’s what we may be overlooking when we choose this quick fix.
Announcing our latest partnership: Gastro Office x Offcall!
🎉 Read about how we're working with gastroenterologists Dr. Krishna Rayapudi, Dr. Rohan Modi, and their innovative gastroenterology practice Gastro Office which is using Offcall to power referrals across their practice.
Biggest predictions for how AI will change psychiatry
Featuring Om Panda, Zain Hussain, and Daniel Lam: How will AI transform this field? Also Download and read our free best-selling e-book with MD+ called “The Physician's Guide to AI” here!
Physician Spotlight: Meet Manijeh Berenji
1. Manijeh, do you think AI will solve the physician shortage or quietly make it worse? No amount of AI/robots will make that inherent need for human interaction go away. In fact, medicine needs to be doubling-down on human-design interaction!
2. What's something physicians are quietly worried about that the public doesn't know about yet? That physicians are not valued as they were in society.
3. Are you worried about deskilling — that the next generation won't develop the intuition you did because the model handled it? I had been initially, but over the last few years, I have seen a new skill come in its place: AI "in"skilling — being able to decipher the AI output, using one's fundamental knowledge about the subject to distill through all the noise and get to the core essence of the subject at hand.
4. Independent practice in 2026 — endangered species or quiet comeback? I predict it is going to come back because of patients' need for real connection with their doctor — not a doc-in-a-box.
5. If you had a magic wand for one thing in medicine — not your whole career, just one thing — what would you fix tomorrow? End prior auth!
Read the full-length version here. Know someone else who should be featured? Reply or tag them and their company in the comments!
Download to join the waitlistMedicine 
is complex enough.
Referrals 
shouldn't be.
Send and receive referrals, build wealth, and grow your physician community with Offcall.
3 Things to Read This Week
Why Physicians Are Losing Their Friends (Medscape, h/t Shamie Das here)
Featuring Brian Garibaldi, Gregory Scott Brown, Jeff Goodloe: 8 in 10 doctors surveyed said their friendships have stayed the same or worsened.
The Trust Layer (MDCalc)
From Graham: “The bottleneck was never the technology’s capability. It was always the trust and GenAI will be no different.”
Why Is Being a Doctor So Hard in 2026? (Dr. Francis Mei Hardin)
“Over the last 60 years, the U.S. healthcare system built layer after layer to code, audit, measure, approve, deny and pay for care.”
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.
More advocacy on Medicare reimbursement
Following up from last week: Dr. Daniel Gibbs posted a pointed response to the latest Medicare Physician Fee Schedule: “Continuing to squeeze physician reimbursement will accelerate the loss of independent private practice while doing little to address Medicare’s underlying spending growth. We are cutting the wrong part of the system. It is time to fix physician payment.” Jacqueline Minick also spoke out here: “Medicare wants to pay $980 for a hip replacement in 2027. A decent set of tires costs about the same. Let that sit for a second.” Also see Preston Alexander’s commentary and Offcall’s story on this topic.
Thanks for sharing, Zayed Yasin
Dr. Zayed Yasin shared an optimistic post about why after 20 years of decline, he believes medicine as a career is about to make a comeback! We sure hope so 🙂Read more here.
Also thanks for sharing, Zeke Walton
Dr. Zeke Walton shared important data about the benefits of physician-owned hospitals: “Medicare pays physician-owned hospitals 8–15% less than traditional hospitals in the same market for similar patients. One analysis found that if Medicare had reimbursed traditional hospitals at physician-owned rates for the 20 most expensive patient categories in 2019, it would have saved ~$1.1B — a 12.2% cut — in that slice alone.” Read more here.
Important video, Sally Primus
Dr. Sally Primus posted an excellent summary video about why we can blame Congress for short doctor appointments. Watch it here.
Congratulations, Zayaan Tirmizi
Dr. Zayaan Tirmizi received his white coat at Duke University School of Medicine! Congratulate him here.
Career news, Baltazar Zavala (h/t Russell Lonser)
Baltazar Zavala is joining the Ohio State University Department of Neurological Surgery! Congratulate him here.
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Download to join the waitlistMedicine is complex enough.
Referrals shouldn't be.
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