How I Doctor with Dr. Graham Walker

By OffcallScience Medicine Health & Fitness

How I Doctor with Dr. Graham Walker episodes

October 01Why Can't Good Medical Advice Go Viral? Dr. Mike Evans on Health Communication in the Influencer Era
Every physician has met the patient who arrives with a confident claim from a feed, a podcast, or a supplement ad. The careful, evidence-based answer is the one that sounds like the outlier. Good medicine is nuanced, and nuance rarely travels.
In this episode of How I Doctor, Dr. John Schumann sits in for Dr. Graham Walker to talk with Dr. Mike Evans, a family physician best known for a whiteboard, a marker, and a question that became a phenomenon: What is the single best thing we can do for our health? Mike practiced inner city family medicine for 15 years, taught at the University of Toronto, and later brought his approach to health innovation at Apple. His whiteboard videos have been watched tens of millions of times.
Mike and John dig into the gap between knowing and doing. Mike shares what he learned about behavior change building health programs at Apple scale, including a 900-person asthma trial published in JAMA that cut emergency room visits by 42% among Medicaid patients. They also take on the influencer economy, from the halo effect to paid promotions, and Mike makes his case that the basics of movement, connection, sleep, diet, and agency still deliver the highest return in health.
The conversation closes with Mike's research on retirement, his read on where wearables and AI are headed over the next year, and the Evans Health Lab Substack he is building as a counterweight to bad influencers.
What You'll Learn
Why the most evidence-based health advice struggles to go viral, and why Mike believes audiences will still reward authenticity
How the halo effect and undisclosed paid promotion shape what patients believe about health
Why behavior change depends more on environment, peers, and personalization than on willpower
What an Apple asthma trial showed about who benefits most from digital health tools
Why the basics still have the best returns in medicine, and what the evidence says about retirement, social connection, and the brain

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31 min
September 24How Dr. Keith Matheny Turned His Practice's Biggest Headaches Into Businesses, While Still Seeing Patients
Most physicians finish training without a single business class, then spend their careers inside practices run the same way. Dr. Keith Matheny decided to fix that, starting with his own.
In this episode of How I Doctor, guest host Dr. Basil Kahwash sits down with Dr. Keith Matheny, an ENT in the Dallas area who holds patents on bioabsorbable drug delivery implants, has co-founded device and remote monitoring companies, serves as team otolaryngologist for the Dallas Cowboys, and still keeps a full clinic schedule. Keith explains how, before he was even a partner, he took over operations at a practice with paper charts, no website, a leaky revenue cycle, and ancillary services that were losing money, and turned it into one with new locations, new referral streams, and service lines that supported the rest of the practice.
That turnaround became a consulting business and then US ENT, a national group purchasing organization. Keith walks through why supply costs have exploded for office-based specialties, why he signed up suppliers before he had a single physician member, and how early suspicion that he was a private equity "Trojan horse" gave way to rapid growth when COVID shutdowns left practices scrambling to make payroll. Today the GPO is free to join and has about 3,500 members.
The conversation closes on why Keith refuses to leave the exam room, how staying clinical keeps him credible with colleagues facing the same rising costs he is, and his advice for physicians who want to build something of their own: get involved, protect your ideas, and just start.
What You'll Learn
What Keith found when he took over the business side of his practice, and how he turned money-losing service lines into profit centers
Why community practice gave him more freedom to patent and commercialize his inventions than an academic path would have
Why Keith recruited suppliers before physicians, and how COVID turned skeptics into members
How rising payroll, rising supply costs, and flat reimbursement are squeezing independent practices, and why Keith feels it as much as his members do
Keith's case for why physicians should shape AI rather than fear it

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28 min
September 17Cut Out the Middleman, Keep the Patients: Dr. Chloe Kindred on Building a Direct Primary Care Practice From Zero
Most doctors who complain about their employed job never actually leave. Dr. Chloe Kindred did, with no backup plan the first time and a real one the second.
In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Dr. Chloe Kindred, a family physician who spent three years in a hospital-affiliated system in Central Florida before leaving to launch Kindred Family Medicine, a direct primary care practice opening this October. Chloe walks through exactly how an employed job that started out manageable became untenable: a starter panel that tripled within months after three colleagues left in close succession, unpaid hours that crept from thirty minutes early into full weekend mornings, and a request to simply pause new patients that her health system flatly refused.
What follows is a real-time account of building an independent practice from nothing, from pricing a subscription against other DPC practices in the region to picking an EHR and billing platform to the bureaucratic loops of setting up basic infrastructure like prescribing credentials. Along the way, an unscripted Instagram post she made mostly so patients could find her after she left turned into 800,000+ views and a 230-person pre-enrollment waitlist, more than double her original year-one goal.
The conversation closes on why Chloe thinks direct primary care specifically, not just independence broadly, is the model that actually removes the risk she couldn't tolerate: a payer able to unilaterally rewrite the terms of her own work.
What You'll Learn
What happened when Chloe asked her health system to simply pause new patient intake, and why the answer was no
The story of her first resignation: submitted with zero plan, rescinded twelve hours later
What actually convinced her to quit for good, and why it wasn't burnout but a single contract email
How she's pricing, staffing, and sizing Kindred Family Medicine, and what tools she chose to run it
Why an unscripted Instagram post now has 800,000+ views, and how it turned into a 230-person waitlist before she saw a single patient
Chloe's case for direct primary care

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📝 For a full transcript of this episode click HERE
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IG https://www.instagram.com/ubergraham/
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36 min
September 10These Physicians Explain Why They'd Never Go Back to Being Employed
Something kept happening on Offcall that we didn’t plan for. Guest after guest, across totally different specialties, kept circling back to the same decision: walking away from employed medicine and building something of their own instead.
This Labor Day, instead of one long conversation, How I Doctor is pulling together the sharpest moments from five of those conversations, physicians in primary care, pediatrics, allergy, and ENT, who each found their own path to independence and never looked back.
Featured in This Episode
Dr. Farzad Mostashari, Former National Coordinator for Health IT and CEO of Aledade: on the economics behind why independent primary care is making a financial comeback, and why he calls employed physicians "cogs in a machine" built around someone else's goals.
Dr. Ari Brown, Pediatrician and founder of 411 Pediatrics: on what it takes to stay independent for over thirty years, and her stark warning that independent pediatric practice is now "on the extinction list."
Dr. Paulius Mui, Family medicine physician and founder of XPC Health: on walking away from full-time employed primary care to build a direct primary care practice where patients pay what they can afford.
Dr. Basil Kahwash, Allergist/immunologist and co-author of Offcall's Referral Manifesto: on the isolation that comes with independent practice, and his vision for a connected network that fixes it.
Dr. Bradley Block, Otolaryngologist and board member at ENT and Allergy Associates: on how a 170-partner, full-equity ownership model became too big and too democratic for private equity to buy.

Resources and Where to Find Our Guests
Dr. Farzad Mostashari's full episode: The Future of Primary Care Is Independence, And It's More Lucrative Than You Think
Dr. Ari Brown's full episode: What Happened to Trust Between Parents and Pediatricians
Dr. Paulius Mui's full episode: Reinventing Primary Care to Put Patients First
Dr. Basil Kahwash's full episode: Going Independent Doesn't Mean Going It Alone
Dr. Bradley Block's full episode: The Physician-Owned Practice That Private Equity Can't Buy
Submit a comment on the CMS CY 2027 Physician Fee Schedule (file code CMS-1848-P): regulations.gov
Read the Referral Manifesto: offcall.com/manifesto
Learn about Offcall's referral product and new Lounges feature: offcall.com/referrals

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IG https://www.instagram.com/ubergraham/
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21 min
September 03Medicine Is Headed Toward Semi-Autonomous Care. Are Doctors Ready? With Counsel Health CMO Rishi Khakhkhar
A recent JAMA perspective argued that AI already outperforms physicians in many cases. One emergency physician building an AI health company thinks that argument gets the timeline right and the conclusion wrong.
In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Dr. Rishi Khakhkhar, an emergency physician at Mount Sinai and Chief Medical Officer of Counsel Health, an AI-enabled virtual care company. Rishi splits his week between ER shifts and building toward what he calls semi-autonomous care, a deliberate middle stage between fully human and fully automated medicine.
The two start with the patients Rishi sees in the ER who never needed to be there, then work through how AI-assisted, physician-supervised care actually functions in practice: an AI takes a full history first, flags when a physician should join, and leaves the decision to escalate in the patient's hands. From there the conversation turns to the JAMA piece itself, with Rishi agreeing that AI can already outperform physicians on narrow tasks like reading subtle EKGs, while pushing back hard on the idea that human-in-the-loop care is holding medicine back. He compares it to Waymo's years of supervised driving before removing the human behind the wheel, and argues medicine shouldn't rush that same transition.
The conversation closes on what's structurally in the way: a 50-state licensing system built for a pre-internet world, the deskilling risk facing residents who train alongside tools that already outperform them, and what Rishi thinks primary care looks like in 2036, when it may no longer be built around a relationship with one person at all.
What You'll Learn
How AI-assisted care actually works: what the AI is allowed to decide, and what always escalates to a physician
Where Rishi agrees and disagrees with the JAMA perspective arguing AI already beats doctors
Why Rishi resists skipping past human-in-the-loop care
What Rishi tells residents they still need to learn without AI, and what he thinks doesn't matter as much anymore
What Rishi thinks primary care looks like by 2036

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36 min
August 27The Physician-Owned Practice That Private Equity Can't Buy With Dr. Bradley Block
Private equity has been buying up ENT and allergy practices at a fast clip. One group has stayed independent and grown into the largest player in its space anyway.
In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Dr. Bradley Block, an otolaryngologist and board member at ENT and Allergy Associates, the country's largest ENT, allergy, and audiology practice. Brad is also the voice behind Succeed in Medicine, a physician communication podcast he ran for years and hundreds of episodes before stepping away this spring.
The two start with why Brad built a podcast in the first place, a solo project born out of a long commute and a simple question: how were his partners seeing more patients per hour than he was without sacrificing the visit. From there the conversation turns to ENTA itself, a practice built on a contract every incoming physician can read on day one, one with a clear, no buy-in path to full equity partnership. That structure now spans roughly 170 partners, and Brad makes the case that scale, not resistance, is exactly what keeps private equity away. He also gets specific about what it costs to build a model like this: founding partners who sacrificed financially to create it, then retired with no buyout at all.
The conversation closes on where the real disadvantage lies for independent practices, not efficiency or leadership, but lobbying power on Capitol Hill, where large health systems can outspend independent groups on influencing the reimbursement rules everyone has to live by.
What You'll Learn
Why Brad built a physician communication podcast because the one he needed didn't exist
How ENTA's contract guarantees a clear, no buy-in path to full equity partnership for every incoming physician
Why a 170 partner structure is nearly impossible for private equity to acquire, and why Brad argues it wouldn't even help
What the founding partners gave up to create the model ENTA runs on today
The one question Brad tells physicians to ask before joining any practice, and why the leverage to ask it disappears the moment they sign

Resources and Where to Find Brad
Find Brad on LinkedIn:
Find Brad's ENTA profile:
Succeed in Medicine (podcast archive): succeedinmedicine.com
Find Brad on Instagram and Threads: @succeedinmedicine

🩺 Offcall is more than a platform — it’s a community. Join today!
📝 For a full transcript of this episode click HERE
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36 min
August 20Dr. Ari Brown on What Happened to Trust Between Parents and Pediatricians
Dr. Ari Brown is a pediatrician in Austin, Texas, who has run her own independent practice, 411 Pediatrics, for more than 13 years and been a pediatrician for more than 30. She's the author of the bestselling Baby 411 series, Baby 411, Toddler 411, and the newly released Expecting 411, books that have sold millions of copies and made her one of the most trusted parent educators in the country. Every new edition means going back and correcting the record, including reversing her own earlier guidance to delay introducing peanuts and eggs once the evidence flipped.
In this episode of How I Doctor, Dr. Graham Walker talks with Ari about what happened to trust between parents and pediatricians, and what it actually takes to hold that trust together while the ground underneath the science keeps shifting. They dig into why vaccines have become victims of their own success, as parents who've never seen measles or chickenpox come to fear the shot more than the disease, and why so many pediatricians have moved onto social media to fight misinformation directly. Ari reframes physicians as teachers first, and walks through the honesty and communication skills she thinks medical training still underserves.
Ari and Graham also get into how instant portal access to labs and imaging has reshaped the emotional weight of practicing medicine, how she coaches families through screens and digital parenting, and what she's seeing families care about most today, from nutrition to developmental milestones. The conversation closes on a warning: with margins this thin, Ari believes independent pediatric practices, and the kind of long-term, trusted care they provide, are genuinely at risk of disappearing.
What You'll Learn
Why Ari calls vaccines "victims of their own success" and what that means for how parents perceive risk
Why she believes physicians are teachers first, and what medical training still gets wrong about communication
How instant portal access to labs and imaging has quietly reshaped physician workload and burnout
What's actually changed for families in the last decade, from screen time to a growing focus on developmental milestones
Why Ari believes independent pediatric practice is at real risk of disappearing, and what's at stake if it does

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34 min
August 13Dr. Karandeep Singh Doesn’t Trust AI Blindly. That’s Exactly Why UC San Diego Health Trusts Him With It
Dr. Karandeep Singh is a practicing nephrologist, an informaticist, and the inaugural Chief Health AI Officer at UC San Diego Health, where he also leads the Joan and Irwin Jacobs Center for Health Innovation. Back in 2021 at the University of Michigan, he published research questioning Epic's own sepsis model, finding it worked only about 63% of the time and that a clinician might have to evaluate eight separate alerts just to find one real case of sepsis. He's one of the rare people who has been on both sides of AI in medicine, exposing a flawed model and now deciding which ones get deployed at all.
In this episode of How I Doctor, Dr. Graham Walker talks with Karandeep about what it actually takes to govern AI inside a health system, and why the doctors who trust AI the least are often the ones best equipped to run it. Karandeep traces his path from teaching himself to code at age eight, through building tools to solve his own clinical frustrations in training, to formally discovering biomedical informatics as a field only during his nephrology fellowship.
Karandeep and Graham dig into why generative AI feels transformative to physicians while predictive AI often doesn't, even when the data shows it's saving lives. They walk through a real case study of using agentic AI to automate pre-colonoscopy prep calls without cutting nurses out of the loop, and unpack what a Chief Health AI Officer's job actually involves day to day. The conversation closes on Karandeep's case for regulatory sandboxes, structured ways to test AI-enabled care models that current rules don't yet allow, and his prediction for where AI scribes are headed next.
What You'll Learn
Why Karandeep's research found Epic's sepsis model wasn't doing what its own model card claimed
Why predictive AI creates work that's hard to feel, while generative AI's time savings are noticeable almost daily
How UC San Diego Health automated colonoscopy prep calls with AI while keeping nurses at the center of care
What a Chief Health AI Officer actually does across evaluation, governance, and implementation
Why Karandeep believes regulatory sandboxes, not blanket approval, are how AI expands access to care

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📝 For a full transcript of this episode click HERE
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36 min
August 06Running Kaiser's Largest Medical Group Taught Former CEO Dr. Robert Pearl What’s Actually Broken in Healthcare
Dr. Robert Pearl spent 18 years as CEO of The Permanente Medical Group, the nation's largest physician-led medical group, where he oversaw the care of more than 5 million Kaiser Permanente members delivered by 10,000 physicians and 38,000 staff. He's since become one of healthcare's most direct critics from the inside, a Forbes healthcare contributor, a LinkedIn Top Voice, and the author of the Washington Post bestseller "Mistreated" and his newest book, "ChatGPT, MD," which argues generative AI will become as essential to physicians as the stethoscope.
In this episode of How I Doctor, Dr. Graham Walker sits down with Robert, his former CEO, to trace some of the hardest calls of his tenure, including the lunchroom video he made to prepare 10,000 physicians and staff for the uncertainty of the Affordable Care Act. That instinct for delivering an uncomfortable diagnosis before anyone wants to hear it runs through the entire conversation.
Robert doesn't think AI's biggest opportunity in healthcare is cutting physician headcount. He argues the real prize, close to $1.8 trillion by his estimate, is preventing the chronic disease that drives most heart attacks, strokes, and kidney failure before it ever starts.
Graham and Robert get into why fee-for-service quietly rewards a patient staying sick, how hospital consolidation and private equity have monetized medicine in ways unique to the United States, why he believes capitation is the prerequisite for AI to actually work, and what a routine doctor's visit could look like in five years if his vision plays out.
What You'll Learn
Why Robert says cutting physician jobs is the wrong AI strategy for hospitals
The real math behind the $1.8 trillion he says is sitting in chronic disease prevention
Why fee-for-service rewards treating a complication over preventing one
How capitation changes what a physician group is financially motivated to want for a patient
What Robert thinks a doctor's visit looks like in five years

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37 min
July 30Dr. Jordan Shlain: Insurance Killed Primary Care, So I Built a Practice Without It
Dr. Jordan Shlain is an internist,= and founder of Private Medical, one of the longest-running concierge practices in the country, and a doctor who has spent 25 years arguing that primary care should never have been bundled into health insurance in the first place. His practice, and his writing on Substack at Don't Listen To Me, have made him one of concierge medicine's most direct voices, direct enough that the New England Journal of Medicine recently devoted a piece to asking whether his model has something to teach the rest of primary care.
In this episode of How I Doctor, Dr. Graham Walker sits down with Jordan to trace the origin story back to when a canceled business meeting sent Jordan wandering into a hotel lobby, where he talked his way into becoming the on-call physician for the Mandarin Oriental. That accidental job became San Francisco On Call Medical Group, then Private Medical in 2002, and eventually a 25-year experiment in what happens when a doctor's incentives and a patient's health point in exactly the same direction.
Jordan doesn't hedge. Insurance, he argues, is a financial hedge against catastrophic loss, not a mechanism for a doctor visit, and folding primary care into that system created most of the dysfunction physicians and patients feel today.
Graham and Jordan get into the actual economics of membership-based primary care, why fee-for-service quietly rewards a patient staying sick, what trust really means when it's stripped down to a promise instead of a marketing term, and why Jordan believes AI will only help physicians if it restores their agency instead of adding another layer of control.
What You'll Learn
Why Jordan argues insurance was never built for routine primary care
The real math behind a membership-based practice
How a flat annual membership changes what a doctor is financially motivated to want for a patient
The real definition of trust
Jordan's prediction that 90 percent of healthcare could already move to email, text, and video
What Jordan would eliminate from healthcare tomorrow if he could

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📝 For a full transcript of this episode click HERE
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34 min

About How I Doctor with Dr. Graham Walker

From the publisher's feed

I built MDCalc 20 years ago because I wanted to save myself and other doctors time and make it easy for them to integrate more evidence into their medical care. Now I’ve launched Offcall to tackle something even bigger: giving doctors back our autonomy — through salary and workload transparency. These ideas shouldn’t be radical…but here we are. I still practice emergency medicine, but I’ve spent my career breaking out of the cookie cutter version of “what a doctor looks like” or “what a doctor’s supposed to do.” That’s why I started How I Doctor: a podcast about the most creative and influential physicians and how they’re rewriting the job description. Medicine wasn’t built for creativity. But I think that’s exactly what it needs. If you’re looking for new role models, different stories, or just proof that fulfillment is still possible in this era of medicine — this show’s for you. Welcome to “How I Doctor,” where we’re bringing joy back to medicine.