On/Offcall: Why Private Practice Physicians Are Making a Bold Comeback!

Offcall Team

Welcome back to On/Offcall!

"Primary care never should have been attached to insurance."

Dr. Jordan Shlain has spent the last 25 years building around this core idea, as the founder of one of the country's longest-running concierge medical practices. This week, Jordan joined Dr. Graham Walker on How I Doctor to discuss why medicine's incentives are broken, what trust really means in healthcare, and why AI should give physicians more agency, not less.

Together, they dive into:
✨ Why Jordan believes primary care should never have been "glommed onto" insurance
✨ How he built a concierge medical practice on referrals alone for a decade
✨ Why he believes a membership model will realign a doctor's incentives with patient health
✨ And more!

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On/Offcall is the weekly dose of information and inspiration that every physician needs.

Announcing: The State of Medicine Project

Offcall and Women in Medicine® are partnering to build a physician-led snapshot of medicine today. If you're a physician, we'd love to hear your perspective. We'll share the State of Medicine findings publicly to elevate physician voices and help shape the future of medicine. Burnout. Compensation. Autonomy. AI. Patient care. Workplace culture. Every response helps paint a clearer picture of what physicians are experiencing, and what needs to change.

Add your voice here

Thanks to the wonderful Women in Medicine® team for your partnership, including: Dr. Shikha Jain, Morgan Collier, Meghan Phillipp, and many more!

Physician Spotlight: Meet Amna Shabbir

1. Amna, do you think AI will solve the physician shortage or quietly make it worse? AI cannot solve a very human issue and need. We're missing the core point of focus: the culture of medicine and the relationship communities have with how they view physicians today. Physicians are leaving medicine in droves, and incoming graduates are hesitant to practice at the bedside because of the absence of basic dignity and employee rights. Wellbeing is still an afterthought, because the expectation is that a physician should suppress their human needs — sleep, rest — under the guise of persistent altruism and self-sacrifice.

While AI can, on the surface, solve for menial tasks like documentation, if the focus still remains greed-driven productivity — where now, with documentation out of the way, maybe a physician should squeeze in double the patient care in that same time slot — it doesn't just miss the point. It makes it worse.

Organizations that see physicians as human beings and celebrate them for that will use AI to their advantage. The others will continue to practice dangerous medicine.

As for patients — a growing number of physicians on social media are sharing their frustration that patients are using AI-generated responses as ammunition to fuel distrust and disrespect, adding to moral injury and burnout. I'm not anti-progress or anti-AI. I remain skeptical, though, about how AI will actually be leveraged to solve for humanity.

2. Independent practice in 2026 — endangered species or quiet comeback? I am so proud of my fellow colleagues who are stepping into independent practice — both through the lens of a physician and a patient. Not endangered. Making a bold comeback, as a way to reclaim autonomy, creativity, and patient advocacy!

3. What's something physicians are quietly worried about that the public doesn't know about yet? I don't think the public fully recognizes the depth of physician responsibilities and expectations — the mental health crisis, the burnout, the moral injury. Physicians are the front-facing players in the field, repeatedly absorbing the backlash for providing care inside a depleted system. They're the easiest to blame when things go wrong.

The public at large truly doesn't understand the mismatch between expectation and reality. And they justify it, in part, by creating mythical salaries around what physicians must be earning. For example, I was sitting across from a non-healthcare friend who was upset that his PCP hadn't replied to a message he'd sent two hours earlier. He said, "If she's earning millions of dollars, she can respond to my message." I — a former PCP — nearly spit out my dinner laughing at how completely justified he felt in his indignation, fully convinced his doctor was pulling in at least a million dollars per year.

The delayed gratification, the cost of medical education, the mental distress, the lack of support — none of that registers for most people. Patients also don't fully grasp that the ridiculous healthcare spending statement they receive has barely anything to do with physician compensation.

And then there's the constant barrage of entities preying on human vulnerability — social media "wellness influencers" and others sowing mass distrust that physicians then have to navigate. Every reel that starts with "Here are 3 things your doctor is hiding from you" will rack up thousands of views and is another blip added to the moral injury metaverse.

All of it is missing a massive point: doctors and patients are both suffering as a consequence of this healthcare system — in their own silos, both deserving better. Communication and compassion are great places to start.

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

Physician unions are surging, and money is not why (KevinMD)
From Dr. Patrick Hudson: Who speaks for the doctors when ownership changes?

Emergency physician burnout and attrition in Canada (CMAJ)
“Of 410 participants, 41 (10%) had left the profession. Among those who remained in emergency medicine and completed the full survey, 69/351 (20%) had taken time off emergency medicine and 170/351 (48%) had reduced their clinical hours in emergency medicine. In total, 229/351 (65%) scored either high emotional exhaustion, high depersonalization, or both.” From Kerstin de Wit, Jasmeet Benepal, Arani Sivakumar, Natasha Clayton, Louise C.F. Rang, Susan A. Bartels, Rodrick K. Lim, Patrick M. Archambault, Teresa M. Chan, Sara Gray, Kerri Ritchie, Caroline Gérin-Lajoie, and Mathew Mercuri

How AI is poised to transform oncology (Offcall)
Featuring Kush Patel, one of the co-authors of Offcall and MD+’s new free ebook The Physician’s Guide to AI. Watch the video and download the book 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.

Well done, Jessie Young and Heidi Health
The team at Heidi Health announced the formation of a U.S. Customer Advisory Board, a group of 12 physicians and clinical leaders who will guide how Heidi's technology is built and deployed as the platform expands across U.S. health systems. Learn more here. Featuring: Dr. Michael Attilio, Dr. David Canes, Dr. Nancy Cibotti, Nancy Farrar, Dr. Shelagh Fraser, Dr. David Klein, Dr. Lawrence Kosova, Johnathan Lyon, Dr. Shelden Martin, Shawn Murphy, Dr. Michael Tang, and Dr. Carrie Weigand.

Fascinating share, Eric Arzubi
Dr. Eric Arzubi shared the fascinating story of how in one Belgian town, psychiatric patients live in strangers' homes. “Not group homes. Not supervised apartments. Actual families, with a spare bedroom and a place set at the table.” Learn more here.

Great interview, Shane Purcell and Mark Cuban
South Carolina-based direct primary care physician Dr. Shane Purcell recently interviewed Mark Cuban about DPC and how he uses it for his companies. Watch it here.

Excellent share, Drew Ratner
Orthopedic surgeon Dr. Drew Ratner compiled a concise table to illustrate his practice's monthly expenses to shed light on the expenses involved in running an independent orthopedic practice. “This context sheds light on the slim margins we face, especially given the relatively low insurance reimbursements in their current form. The proposed Medicare cuts add further strain to the system.” Read more here.

Thanks for sharing, Jesse Pines and Art Papier
Dr. Art Papier weighed in on the recent lawsuit against ChatGPT by a Florida pastor, sharing his thoughts from a liability and physician perspective. Dr. Jesse Pines also shared his reaction to the lawsuit and the research here.

Congratulations, Emma Skeel
Medical student Emma Skeel announced that she received her white coat! “Receiving my white coat at the University of Pittsburgh School of Medicine is both an incredible honor and a reminder of the responsibility that comes with the privilege of caring for others.” Learn more here.

Congratulations, Dr. Brian Hoeflinger
Neurosurgeon Dr. Brian Hoeflinger announced his retirement after starting his journey to be a neurosurgeon over 40 years ago. “Now being almost 62 years old, I realize it’s time to let go and pursue other interests in life. It wasn’t an easy decision but I know it’s the right one. After being on call over half of my life, it will be nice to sleep in and no longer be woken up in the middle of the night for an emergency.” Celebrate him here.

Also congratulations, Grace Torres Hodges
Dr. Grace Torres Hodges announced that she has been named one of the 26 Podiatrists to Follow in 2026 by Dr. Jim McDannald. Celebrate her here.

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Introducing: Offcall Referrals!

We’re building an invite-only network and tool for physicians to communicate with other doctors and send referrals effortlessly with one tap, regardless of EMR (think private WhatsApp for and by doctors). We’re excited to meet primary care doctors and specialists who want to build up their practice and be part of this growing network. Want to be invited? Reply or reach out directly: contact@offcall.com.

Learn More Here