Telehealth Isn't Enough for Rural Patients. Northwell's Dr. Chethan Sathya on Remote Monitoring, Home-Based Care, and Who Will Pay for It

Key Podcast Moments

• After screening more than 400,000 patients, Chethan reveals that gun owners are the program's biggest supporters
• Graham and Chethan discuss why recruiting specialists to live in every rural town is a plan that has never worked
• Chethan describes tech-enabled care as far more than a video visit, from remote monitoring to specialists on call for quick referral touchpoints
• Chethan says outside of stroke, reimbursement for virtual care is not great, and asks where the business model is

Gun violence is an issue many had written off as a political dead zone. One surgeon turned it into a screening question that now lives inside Epic, and he is taking the same approach to a very different problem. In this episode of How I Doctor, Dr. Graham Walker sits down with Dr. Chethan Sathya, a pediatric trauma surgeon at Cohen Children's Medical Center and Vice President of Strategic Initiatives at Northwell Health, to ask why a patient in rural America can't see a specialist, and whether a public health playbook can close that gap.

Chethan's second career started in his first week as an attending, when he operated on a six-month-old with a gunshot wound. The baby survived. Chethan went on to found Northwell's Center for Gun Violence Prevention and build We Ask Everyone, a firearm risk screening protocol that began in three emergency departments and is now available nationally through Epic. He also worked on All the Empty Rooms, which won this year's Oscar for Best Documentary Short, and earned a journalism degree during residency because research alone wasn't moving policy or the public. What sets his approach apart is nuance. Mass shootings, suicides, accidental injuries, and urban violence carry very different risk factors, and Chethan argues that policies sold as answers to all of them lose the communities they need. Northwell asks every patient about firearm risk the way it asks about substance use, using a harm reduction approach that respects autonomy. After screening more than 400,000 patients, he says gun owners have become the program's biggest supporters.

The bulk of the conversation turns to rural specialty access. Chethan helped launch the National Specialty Care Access Coalition, a health system led group of more than 20 systems, and he says its playbook mirrors the gun violence work: mobilize hospitals, which are often the largest lobby or employer in any state. The coalition focuses on specialty care because primary care in rural America is already falling short, which makes specialty access even worse. His argument is that recruiting specialists to live in every part of the country is over, and that the unlock is tech-enabled care, not just a clinician on a screen. That means remote patient monitoring, care delivered in the community and at home, and upskilled primary care. At Sevaro, where he is chief physician executive, Chethan is rethinking specialist workflows so clinicians can take quick referral touchpoints instead of spending eight hours in clinic. Graham describes a referral platform his team is building that would flag a missing sinus CT before an ENT visit, turning two visits into one.

None of it works without someone being paid to do it. Chethan says reimbursement for virtual care visits, apart from stroke, is not great, and that incentives have to reach local hospitals so they don't disappear or go bankrupt, rather than only supporting academic medical centers. Graham presses on the tension of hospitals as both businesses and community lifelines, citing the ripple effects when Beth Israel closed in Manhattan. Chethan, who is originally from Canada and trained in Toronto, says most health systems run on slim margins, and points out that Northwell is New York State's largest employer, which makes jobs a public health intervention too. The episode closes on policy: licensure and credentialing barriers that Chethan says are huge and have shown little progress, and a hope that the new Congress keeps its focus on big pharma, price transparency, and affordability.

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

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Top 4 Takeaways

Rural access will not be fixed by recruiting more specialists or by adding more video visits. What Graham and Chethan surface in this conversation is what tech-enabled care actually requires, and who has to be paid for it to work.