Emily Leventhal is a third-year MD-PhD student at the Icahn School of Medicine at Mount Sinai. Rishma Jivan is a fourth-year at Rush Medical College who spent years inside San Francisco health tech startups before going back to medical school. Together they co-led The Physician's Guide to AI, a nine-specialty e-book built with more than 40 physician authors, published in partnership with MD+.

In this episode of How I Doctor, Dr. Graham Walker sits down with Emily and Rishma to find out what medical training actually looks like from inside the AI shift. What's really happening on rotations, in the hallways, and in the conversations students are having with attendings who don't always know what to make of it.

They dig into the "hidden curriculum," the unwritten norms of medical training that AI is starting to help close for students who don't come from medical families, and why Rishma refuses to let herself trust an AI output without teaching herself to critique it first. Emily makes the case that AI won't just change how physicians practice, it will change which specialties students choose to go into at all. And both push back on the idea that relying on these tools is a shortcut, describing it instead as a discipline they're still building the rules for in real time.

This isn't about students skipping the hard parts of training. It's about a generation building the habits and guardrails the rest of medicine hasn't caught up to yet.

📖 Download The Physician's Guide to AI: https://www.amazon.com/dp/B0GY36B58Z

What You'll Learn

• Why every medical student is already using ChatGPT to prep for cases, and why that's different from the smaller group actually building AI tools.
• What the "hidden curriculum" is, and how AI is helping close that gap for students without a medical background in the family.
• How to guard against automation bias: the habit of verifying an AI output against its source before trusting a clinical recommendation.
• Why AI's impact on a specialty may become a real factor in how students choose where to train.

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Dhruv Khullar is a hospitalist at New York Presbyterian, a health policy researcher at Weill Cornell, and a contributing writer to The New Yorker. That combination is rarer than it should be. Most physicians writing about medicine observe it from a remove. Dhruv rounds on patients in the morning, then sits down to report on what medicine is becoming for one of the most widely read publications in the country. What he writes carries clinical weight because he was just in the room.

Over the past several years, Dhruv has reported at length on AI and its risks for clinical training, the structural forces reshaping the profession, and what he calls the Gilded Age of American medicine: dazzling innovation on the surface, structural rot underneath. That rot has a specific anatomy. Private equity now owns roughly 500 hospitals in the United States, and in some markets a single firm controls more than half of physician practices in a given specialty. Medicare Advantage insurers have turned risk-adjusted payment into a revenue strategy, systematically capturing diagnostic codes for conditions patients may not know they have and that no physician is treating, because sicker-looking patients generate more money. The value-based care revolution that many physicians believed in, Dhruv included, has not delivered on its promise. And all of it is happening while AI is simultaneously raising the ceiling of what medicine can do and quietly lowering the floor of what training physicians are being asked to do themselves.

In this episode of How I Doctor, Graham sits down with Dhruv to get into what his reporting has actually uncovered and what it means for physicians living inside this moment. They talk about the difference between cognitive deskilling and cognitive foreclosure: the risk that medical trainees who turn to AI before doing the hard thinking themselves may never build the reasoning infrastructure that clinical judgment depends on. Dhruv describes watching an AI model called Cabot go head to head with one of the best diagnosticians he has ever trained alongside on a New England Journal CPC case, and nearly gasping when the machine finished in minutes. They also get into what happens to medical authority when a patient in your ER trusts ChatGPT over the physician standing in front of them, how Medicare Advantage is being gamed, and whether medicine can still be a calling after the system has spent years making it feel like a job.

What You'll Learn in This Episode:

• Why cognitive foreclosure may be a bigger threat to physician training than cognitive deskilling
• What Dhruv witnessed when an AI went up against one of the best diagnosticians he has ever trained alongside, on one of medicine's hardest diagnostic case formats, and why it made him nearly gasp
• How Medicare Advantage insurers have turned risk adjustment into a revenue strategy
• Why the most successful version of physician advocacy will be built around patient needs rather than professional status
• Whether medicine can still be a calling after the system has spent years turning it into a job

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Dr. Michael Pfeffer is Stanford Healthcare's Chief Information Officer and a practicing hospitalist, which means he builds AI tools in the morning and uses them on patients that afternoon. That combination is rarer than it should be, and it shapes everything about how he thinks.

Stanford is one of the most AI-forward health systems in the country. It runs 1,500 software applications, has put generative AI into the hands of its clinicians through ambient documentation and a plain-language chart querying tool called ChatEHR, and has published the outcomes of all of it, including the parts that did not go as expected. Mike's argument is that none of that is the point. Healthcare spends three times more on AI than any other industry, and most of that investment is going toward automating processes that were broken to begin with. Digitizing the way medicine has always been done is not transformation. The real opportunity is redesigning what the encounter itself looks like, offloading guideline-driven busywork to agents that can own it, and building toward a world where the right test is ordered the first time and the right drug is prescribed before the patient leaves the room.

In this episode of How I Doctor, Graham sits down with Mike to get into what Stanford has actually built, what the data shows, and what distinguishes a health system that deploys AI responsibly from one that just deploys it. They also get into clinical AI governance, how physicians interact with decision support versus how they should, whether the next generation of trainees is losing its curiosity or still has it, and what Mike's ideal AI-enabled hospital day actually looks like in five years.

What You'll Learn in This Episode:

• What the difference between digitizing and transforming healthcare actually means in practice
• Why healthcare spending more on AI than any other industry may be a sign of lag, not leadership
• How Stanford uses the FURM framework to evaluate every AI application
• Why the biggest mistake medicine could make with AI is buying a lot of it without understanding the value, and what responsible deployment actually requires
• Why Mike is less worried about AI deskilling the next generation of physicians than most and what he saw on rounds last week that gave him confidence

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Dr. Orange is a primary care physician, one year out of residency, practicing somewhere in the United States at a health system she can't name. She posts on TikTok as a talking orange, with her face obscured and her voice altered, because showing up as herself would cost her too much. Her employer might find out. Her patients might lose confidence in her. And after years of training and too much debt, she cannot afford either.

What she says from behind that mask is not radical. It is what physicians say to each other in workrooms, in parking lots, in group texts that will never see the light of day. That the job is not what they signed up for. That the administrative burden is crushing. That corporate medicine has turned patient care into customer service. That they feel like children being managed by a system that owns them.

She said it anyway. Thousands of people have found her.

In this episode of How I Doctor, Dr. Graham Walker sits down with Dr. Orange for the most candid conversation about the state of medicine you will hear from a physician who is still inside it. They cover the financial trap that keeps early-career doctors locked in jobs they want to leave, the expectation gap that nobody warns you about before you become an attending, what would actually have to change for her to love her job, and why the anonymous fruit salad of healthcare workers she accidentally created online is one of the most honest signals medicine has produced in years.

What You'll Learn in This Episode:

• Why physicians who speak honestly about hating their jobs risk their patients, their employers, and their careers, and what it says about medicine that anonymity is the only safe container for that conversation
• What the first year of attending life actually looks like when residency ends and the full weight of portal messages, non-clinical requirements, and production pressure lands all at once
• How student loan debt and restrictive contracts function as a structural trap that keeps early-career physicians in systems that are making them miserable
• Why autonomy, not salary, may be the variable that determines whether the next generation of physicians stays in medicine at all

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Dr. Wendy Dean is a psychiatrist, author, and the co-founder of Moral Injury of Healthcare, a nonprofit dedicated to understanding and alleviating clinician distress. In 2018, she co-wrote a 500-word op-ed in STAT News that did something rare: it handed an entire profession the language for something most physicians had been carrying alone. The argument was simple and devastating.

Physicians aren't burning out.

That implies a personal failure of resilience. What's actually happening is moral injury, the damage that accumulates when you are repeatedly forced to act in ways that violate your own moral code.

That piece started an international conversation that Wendy has been leading ever since, through her book "If I Betray These Words," her podcast 43cc, and her ongoing research and consulting work with health systems around the world.

In this episode of How I Doctor, Dr. Graham Walker sits down with Wendy to go deep on what moral injury actually is, why getting the language right matters so much, and what a healthcare system that takes clinician distress seriously would actually need to look like. They cover AI's entry into an already fractured system, the EMR as a cautionary tale the profession is at risk of repeating, and the grief that comes with watching a profession you love get slowly hollowed out.

What You'll Learn in This Episode:

• Why burnout and moral injury are distinct problems that require fundamentally different solutions, and why naming it correctly changes where responsibility sits
• What it actually feels like to be morally injured, and why the absence of a bid to repair a betrayal is often where the real damage sets in
• How physicians are trained to be independent thinkers and then placed in systems that give them no authority, no agency, and all of the responsibility
• Why Wendy believes AI is walking into the same trap as the EMR, and what the liability question nobody in health law has answered yet tells us about where this is heading
• What gives Wendy genuine hope that medicine gets to the other side, and why the grief physicians are carrying right now is also a signal that the fight is not over

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Mentioned in this episode:

It's all coming together

Abridge is hosting its first-ever Keynote, live from New York City and streaming globally for the Offcall community. Join Abridge CEO and Founder, Dr. Shiv Rao, for a presentation on the future of AI in healthcare.

Dr. John Whyte is a board-certified internist who has spent his career at the intersection of medicine, policy, media, and technology. He served at the FDA, built a reputation as one of medicine's most trusted public communicators at WebMD, and 10 months ago became CEO and Executive Vice President of the American Medical Association, the oldest and largest physician organization in the United States.

Whyte came into the role with a candid assessment: the AMA had lost some of its relevance and impact, and needed to become a real force for physicians and patients in Washington again. He's now leading that effort at a moment when the profession is navigating burnout, prior authorization, scope creep, a rapidly shifting AI landscape, and a payment system that fails to make the case for what physicians actually contribute to patient safety and access.

In this episode of How I Doctor, Dr. Graham Walker sits down with John to cover what the AMA is focused on right now and why, how AI is already reshaping the way physicians practice whether they're ready or not, and what it means that the efficiency gains from AI tools are largely flowing to health systems rather than back to physicians or patients. They also get into the harder question underneath all of it: who speaks for physicians when the stakes are this high, and what happens to the profession if physicians stay on the sidelines.

What You'll Learn in This Episode:

• Why physician burnout remains at 40% across the profession and above 50% in emergency medicine and OB-GYN, and why the AMA believes it has to be solved at the systems level
• How AI adoption among physicians jumped from 38% to 81% in three years, and why that speed of uptake hasn't translated into more time with patients
• Why the real argument for physician payment is not compensation but patient safety and how the public narrative gets this wrong
• What the AMA is doing on prior authorization and scope creep, and why those are the two issues where physicians are most aligned across specialties

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📝 For a full transcript of this episode click HERE

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Dr. Rana Awdish is a pulmonologist, critical care physician, and Medical Director of Care Experience at Henry Ford Health in Detroit. She is also the author of In Shock, a book that has changed the way countless physicians walk into a patient's room, and her new book After Shock, which picks up where that story left off.

Rana nearly died as a fellow from a catastrophic illness that left her hospitalized in the very system she had trained inside. What she heard, experienced, and absorbed from the other side of the bed became the foundation for a decade of research into how medical language shapes patient outcomes.

In this episode of How I Doctor, Dr. Graham Walker sits down with Rana to explore what it actually means to heal, both for patients and for the physicians caring for them. They dig into Rana's Never Words research, published in Mayo Clinic Proceedings, which identifies specific phrases physicians use that strip power from patients and offers concrete alternatives. And they get into the harder questions: how do you build trust with patients, why the data shows compassionate care actually makes clinical visits more efficient, and what it means that medicine has spent decades rewarding physicians for ignoring their own bodies.

What You'll Learn in This Episode:

• The specific words and phrases from Rana's Never Words list that physicians should stop using, and what to say instead
• Why redistributing power through language is not just ethical but changes clinical outcomes including adherence and return visits
• Why medicine rewards disembodiment in physicians and what the cost of that has been for trainees, patients, and the profession
• What curiosity can do when every other communication tool has run out
• Why the culture of medicine is not fixed, and what physicians can actually do to reshape it from within

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📝 For a full transcript of this episode click HERE

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Dr. John Dayton is an emergency physician, Stanford innovation fellow, and co-founder of Wildfire Partners, a new healthcare seed fund built around a simple but data-backed conviction: physicians make better health tech founders than the industry has ever given them credit for.

The data is hard to ignore: more than a quarter of billion-dollar healthcare companies built in the last decade had at least one clinician co-founder. John did not just write that paper. He built a fund around it.

In this episode of How I Doctor, Dr. Graham Walker sits down with John to dig into what it actually takes to build a health tech company worth funding. They walk through John's Seven Ps framework for evaluating startups, what makes a pitch compelling versus an instant red flag, and why the barrier to entry for physician-founders has never been lower thanks to AI.

What You'll Learn in This Episode:

• The Seven Ps framework John uses to evaluate every health tech company he considers funding
• What kills a pitch immediately and what signals a founder has actually done their homework
• Why AI has dramatically lowered the barrier to entry for physician-founders and what that changes about building a company today
• How to think about the principal-agent problem when selling into health systems
• Why ambient AI tools matter more for physician burnout than the time savings data alone suggests
• What John learned about scalable, practical problem solving from practicing in resource-poor clinical environments
• What winning actually looks like and why it is about more than financial

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Most physicians have had a referral disappear. Many have spent days tracking down a colleague just to coordinate care for a single patient.

In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Dr. Basil Kahwash, an allergist and immunologist in Columbus, Ohio, to talk about one of the most universal and underappreciated problems in medicine: the referral system is broken, and independent physicians are paying the highest price.

Basil didn't set out to become an advocate for fixing referrals. He trained at Vanderbilt, where reaching a collaborating physician was as simple as sending an Epic message or jumping on a 20-minute Zoom call with three specialists at once. Then he went into independent practice in Columbus and discovered that none of that infrastructure existed. No shared records. No easy way to reach a referring physician. No directory of local specialists. Just a fax machine, a stack of paper charts, and a phone number he hoped was still current.

The referral black hole isn't just a physician frustration. It's a patient safety problem. Basil shares the story of a pregnant patient with a rare drug allergy whose referring OB-GYN he couldn't reach for three to four days. These aren't edge cases. They're a typical Tuesday.

Graham and Basil co-authored the referral manifesto at offcall.com/manifesto, making the case that independent practice doesn't have to mean isolated practice. This episode is the conversation behind that letter: what's actually broken, what it costs physicians and patients, and what a connected network of independent physicians could change.

What You'll Learn

• How patients have become the de facto middlemen in a system that has no better option
• Why most referrals arrive as little more than a diagnosis code, and what even a small amount of added context would change
• How the fax machine became the rate-limiting step for physician collaboration and why EHRs haven't solved the problem
• Why hyperlocal physician networks exist within specialties online but not across specialties within cities, and what filling that gap could look like
• What winning looks like if the referral problem gets solved: coordination fades into the background and physicians get back to patient care

Resources and Where to Find Basil and Offcall

• Read the Referral Manifesto: offcall.com/manifesto
• Learn about the Offcall Referral Product: offcall.com/referrals
• Find Basil on LinkedIn: linkedin.com/in/basil-kahwash-md
• Find Graham on LinkedIn: linkedin.com/in/graham-walker-md

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📝 For a full transcript of this episode click HERE

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Most physicians know a colleague who has struggled. Many know one who didn't make it.

In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Dr. Stefanie Simmons, Chief Medical Officer of the Dr. Lorna Breen Heroes' Foundation and practicing emergency physician in Ann Arbor, Michigan, for one of the most important conversations in medicine right now.

Physician mental health isn't an abstract policy issue.

It's the licensing form that places a mental health history question directly after "are you a pedophile." It's the peripartum depression Stefanie developed during her own residency that she never treated because a formal diagnosis felt like a career risk. It's Dr. Lorna Breen, chair of emergency medicine at New York Presbyterian, working 18-hour days through the first COVID wave in Manhattan, who received mental health care and told her family she was terrified it would cost her her license.

Stefanie didn't know Lorna before her death. But like every emergency physician in the country, she was one degree of separation from her. And when Lorna's family started hearing from hundreds, then thousands, of healthcare workers who said "she wasn't alone," Stefanie was one of the people who called.

Stefanie makes the case that physician mental health is a systems failure, not a personal one, and that the fix is structural. The foundation has already changed the credentialing language at more than 2,000 hospitals and across 70 state licensing boards, covering more than 3 million health workers. The Lorna Breen Healthcare Provider Protection Act was reauthorized in February 2026. The calculus is shifting. But the work is far from complete.

This episode is an honest conversation about why physicians won't seek mental health care, what it costs when they don't, and how one foundation is rebuilding the system from the inside out.

What You'll Learn

• How the Dr. Lorna Breen Healthcare Provider Protection Act works, what it funds, and why its reauthorization matters for every physician
• How a single question on a licensing application has kept generations of physicians from getting help, and what the foundation is replacing it with
• Why physicians massively overestimate how much their colleagues will judge them for seeking mental health care, and what the data actually shows
• What Stefanie's own experience with peripartum depression during residency taught her about the cost of not getting help
• Why burnout is an occupational syndrome, not a personal failing
• What a struggling physician can do right now, and where to find support

If You or a Colleague Need Help

• 988 Suicide and Crisis Lifeline: call or text 988 / 988lifeline.org
• Physician Support Line: free, confidential, anonymous, staffed by psychiatrists / 1 (888) 409-0141 / physiciansupportline.com
• Emotional PPE Project: free anonymous mental health care for clinicians / emotionalppe.com
• All For Mental Health resource hub: drlornabreen.org/all-for-mental-health

Resources and Where to Find Stefanie and the Foundation

• Dr. Lorna Breen Heroes' Foundation: drlornabreen.org
• Take Action: drlornabreen.org/take-action
• All In Wellbeing First for Healthcare Coalition: drlornabreen.org/all-in
• Find Stefanie on LinkedIn: https://www.linkedin.com/in/stefsimmons/
• Follow the Foundation on Instagram: https://www.instagram.com/drlornabreenheroesfoundation/

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