Primary Care Is the API for Healthcare. So Why Is Nobody Building for It? with Jefferson Health’s Dr. David Nichols

Key Podcast Moments

• David explains why primary care is the API for healthcare, and why it is a poorly written one
• David tells the story of stepping off ICU rounds to negotiate a contract with Blue Cross Blue Shield, then returning to being just a med student
• Michael questions whether a million doctor hours saved really means anything, and David explains why AI scribes may improve visits without saving time
• David describes a future where every patient and every physician has their own AI, working together with a human on the loop

Ask a primary care doctor what the job really is, and the honest answer is everything the rest of the system doesn’t do. Records get lost between the hospital and the clinic. Specialists don’t talk to each other. Someone has to notice, chase it down, and put the pieces back together. That work is rarely visible, rarely billed, and almost never designed for.

In this episode of How I Doctor, Dr. Michael Hobbs sits in for Dr. Graham Walker to talk with his friend Dr. David Nichols, a family physician who finished residency in 2023 and became a medical director at Jefferson Health one year later. Michael is a direct primary care pediatrician in Minneapolis and the creator of AI 101, a free guide that helps clinicians get started with AI. David’s path to that role was not typical. He studied physiology with a focus on prevention, co-founded a value-based care company at 23, and ran its technology and telehealth side through medical school and part of residency. When he finally left that company, he spent a year as an attending, interviewed for 21 jobs, and kept sounding like a medical director in all of them.

At the center of the conversation is an idea David helped put into writing: primary care is the API for healthcare. An API is the connector that lets different systems talk to each other, and in the ambulatory world, he argues, primary care plays that role between specialists, the hospital, and patients’ lives at work and in their communities. The catch is that this connector is poorly structured, so primary care doctors fill the gaps by hand. David also makes the case that primary care physicians should be building tools, not just adopting them, and explains how a clinician with an idea can find the right people, inside their own system and out.

Michael and David close by turning to what makes AI work inside a large health system. David explains why projects stick when they align with a system’s goals and why hours saved is a tricky measure of success. He also names a structural problem he would fix first: physicians are paid for time spent in the same room as a patient, not for the coordination and thinking that make that time safe. He ends with his hope for a future where patients and physicians each have an AI of their own, working together with a human on the loop.

This episode is presented in partnership with eNavvi, a clinician-built digital prescribing platform.

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Top 4 Takeaways

David’s argument is that primary care already does the integration work the rest of healthcare never built, and that the people best placed to fix it are the ones doing it by hand. Four ideas stand out.