How I Doctor with Dr. Graham Walker

Offcall
  • 4.8 (20)
  • Medicine
  • Updated Weekly

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. If you enjoy the show, please hit the follow button! That will help us continue to bring you more great episodes every week. And don’t forget to sign up for Offcall. Join the growing movement! Offcall: https://www.offcall.com/ LI: https://www.linkedin.com/company/joinoffcall TikTok: https://www.tiktok.com/@offcalldotcom IG: https://www.instagram.com/offcalldotcom/

  1. 21h ago

    Medicine 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 physicianWhere Rishi agrees and disagrees with the JAMA perspective arguing AI already beats doctorsWhy Rishi resists skipping past human-in-the-loop careWhat Rishi tells residents they still need to learn without AI, and what he thinks doesn't matter as much anymoreWhat Rishi thinks primary care looks like by 2036 🩺 Offcall is more than a platform — it’s a community. Join today! 📝 For a full transcript of this episode click HERE 🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315 👨‍⚕️Follow Dr. Graham Walker on LinkedIn https://www.linkedin.com/in/graham-walker-md/ IG https://www.instagram.com/ubergraham/ Bluesky https://bsky.app/profile/drgrahamwalker.com ✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 🟧 Follow Offcall on LinkedIn https://www.linkedin.com/company/joinoffcall/ IG https://www.instagram.com/offcalldotcom/ TikTok https://www.tiktok.com/@offcalldotcom

    Medicine Is Headed Toward Semi-Autonomous Care. Are Doctors Ready? With Counsel Health CMO Rishi Khakhkhar

  2. Aug 27

    The 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 existHow ENTA's contract guarantees a clear, no buy-in path to full equity partnership for every incoming physicianWhy a 170 partner structure is nearly impossible for private equity to acquire, and why Brad argues it wouldn't even helpWhat the founding partners gave up to create the model ENTA runs on todayThe 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 🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315 👨‍⚕️Follow Dr. Graham Walker on LinkedIn https://www.linkedin.com/in/graham-walker-md/ IG https://www.instagram.com/ubergraham/ Bluesky https://bsky.app/profile/drgrahamwalker.com ✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 🟧 Follow Offcall on LinkedIn https://www.linkedin.com/company/joinoffcall/ IG https://www.instagram.com/offcalldotcom/ TikTok https://www.tiktok.com/@offcalldotcom

    The Physician-Owned Practice That Private Equity Can't Buy With Dr. Bradley Block

  3. Aug 20

    Dr. 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 riskWhy she believes physicians are teachers first, and what medical training still gets wrong about communicationHow instant portal access to labs and imaging has quietly reshaped physician workload and burnoutWhat's actually changed for families in the last decade, from screen time to a growing focus on developmental milestonesWhy Ari believes independent pediatric practice is at real risk of disappearing, and what's at stake if it does 🩺 Offcall is more than a platform — it’s a community. Join today! 📝 For a full transcript of this episode click HERE 🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315 👨‍⚕️Follow Dr. Graham Walker on LinkedIn https://www.linkedin.com/in/graham-walker-md/ IG https://www.instagram.com/ubergraham/ Bluesky https://bsky.app/profile/drgrahamwalker.com ✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 🟧 Follow Offcall on LinkedIn https://www.linkedin.com/company/joinoffcall/ IG https://www.instagram.com/offcalldotcom/ TikTok https://www.tiktok.com/@offcalldotcom

    Dr. Ari Brown on What Happened to Trust Between Parents and Pediatricians

  4. Aug 13

    Dr. 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 claimedWhy predictive AI creates work that's hard to feel, while generative AI's time savings are noticeable almost dailyHow UC San Diego Health automated colonoscopy prep calls with AI while keeping nurses at the center of careWhat a Chief Health AI Officer actually does across evaluation, governance, and implementationWhy Karandeep believes regulatory sandboxes, not blanket approval, are how AI expands access to care 🩺 Offcall is more than a platform — it’s a community. Join today! 📝 For a full transcript of this episode click HERE 🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315 👨‍⚕️Follow Dr. Graham Walker on LinkedIn https://www.linkedin.com/in/graham-walker-md/ IG https://www.instagram.com/ubergraham/ Bluesky https://bsky.app/profile/drgrahamwalker.com ✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 🟧 Follow Offcall on LinkedIn https://www.linkedin.com/company/joinoffcall/ IG https://www.instagram.com/offcalldotcom/ TikTok https://www.tiktok.com/@offcalldotcom

    Dr. Karandeep Singh Doesn’t Trust AI Blindly. That’s Exactly Why UC San Diego Health Trusts Him With It

  5. Aug 6

    Running 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 hospitalsThe real math behind the $1.8 trillion he says is sitting in chronic disease preventionWhy fee-for-service rewards treating a complication over preventing oneHow capitation changes what a physician group is financially motivated to want for a patientWhat Robert thinks a doctor's visit looks like in five years 🩺 Offcall is more than a platform — it’s a community. Join today! 📝 For a full transcript of this episode click HERE 🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315 👨‍⚕️Follow Dr. Graham Walker on LinkedIn https://www.linkedin.com/in/graham-walker-md/ IG https://www.instagram.com/ubergraham/ Bluesky https://bsky.app/profile/drgrahamwalker.com ✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 🟧 Follow Offcall on LinkedIn https://www.linkedin.com/company/joinoffcall/ IG https://www.instagram.com/offcalldotcom/ TikTok https://www.tiktok.com/@offcalldotcom

    Running Kaiser's Largest Medical Group Taught Former CEO Dr. Robert Pearl What’s Actually Broken in Healthcare

  6. Jul 30

    Dr. 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 careThe real math behind a membership-based practiceHow a flat annual membership changes what a doctor is financially motivated to want for a patientThe real definition of trustJordan's prediction that 90 percent of healthcare could already move to email, text, and videoWhat Jordan would eliminate from healthcare tomorrow if he could 🩺 Offcall is more than a platform — it’s a community. Join today! 📝 For a full transcript of this episode click HERE 🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315 👨‍⚕️Follow Dr. Graham Walker on LinkedIn https://www.linkedin.com/in/graham-walker-md/ IG https://www.instagram.com/ubergraham/ Bluesky https://bsky.app/profile/drgrahamwalker.com ✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 🟧 Follow Offcall on LinkedIn https://www.linkedin.com/company/joinoffcall/ IG https://www.instagram.com/offcalldotcom/ TikTok https://www.tiktok.com/@offcalldotcom

    Dr. Jordan Shlain: Insurance Killed Primary Care, So I Built a Practice Without It

  7. Jul 23

    51 of the Top 100 Healthcare Companies Had a Physician Founder: Dr. David Lortscher Explains Why

    Dr. David Lortscher is a dermatologist turned founder of Curology, one of the first companies to combine telehealth, prescription skincare, and a subscription model into something patients would actually use. He's also the author of a new book making a data backed case that should unsettle every hospital administrator who's ever doubted a physician founder: Why Doctors Win. In this episode of How I Doctor, Dr. Graham Walker sits down with David to trace his path from a dermatopathology fellowship waiting for him at UCLA to starting Curology, and then a decade later stepping back from the CEO seat. That gave him time to go looking for proof that his own success wasn't a fluke. What he found is that 51 of the top 100 healthcare companies founded in the last 40 years had a physician founder! Graham and David get into why the doctor plus engineer pairing keeps showing up in the biggest healthcare success stories, the blind spot that trips up even smart physician founders, and David's blunt rule for anyone gathering advice before making the leap: take the inputs, not the conclusions. What You'll Learn Why physician founded healthcare companies outperform at roughly 3x the rate you'd expect from their overall representation among foundersThe doctor plus engineer combination that shows up in 7 of the 10 companies profiled in Why Doctors Win, and why it worksHow an MD behind your name changes the way you sell into a hospital, from the CMO's office up to the CEO and CFOThe most common blind spot physician founders hit: falling for the technology itself instead of the harder question of who will actually pay for itDavid's rule for gathering advice from as many people as possible while still keeping the final decision your own 🩺 Offcall is more than a platform — it’s a community. Join today! 📝 For a full transcript of this episode click HERE 🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315 👨‍⚕️Follow Dr. Graham Walker on LinkedIn https://www.linkedin.com/in/graham-walker-md/ IG https://www.instagram.com/ubergraham/ Bluesky https://bsky.app/profile/drgrahamwalker.com ✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 🟧 Follow Offcall on LinkedIn https://www.linkedin.com/company/joinoffcall/ IG https://www.instagram.com/offcalldotcom/ TikTok https://www.tiktok.com/@offcalldotcom

    51 of the Top 100 Healthcare Companies Had a Physician Founder: Dr. David Lortscher Explains Why

  8. Jul 16

    What Does Good AI in Healthcare Look Like? CHAI CEO Brian Anderson Is Trying to Get Every Hospital in America to Agree

    Dr. Brian Anderson is a pediatrician turned CEO of the Coalition for Health AI (CHAI), the organization behind the push to give every AI tool in your EHR something like a nutrition label: what it was trained on, who trained it, and where it might fail. In this episode of How I Doctor, Dr. Graham Walker sits down with Brian to trace his path from a Mass General exam room, where a clunky EHR rollout first pushed him toward building technology instead of just using it, to running a coalition of more than 3,000 organizations trying to agree on one deceptively hard question: what does good AI in healthcare actually look like. They also break two major pieces of news together, live on the show. OpenAI and Anthropic are donating thousands of AI licenses to public health agencies through CHAI, aimed at rebuilding trust in digital tools after decades of underinvestment. And CHAI is launching a health sector specific version of Anthropic's Project Glasswing, bringing serious cybersecurity firepower to the industry Brian calls the most attacked critical infrastructure in the country. Graham and Brian also get into what "human in the loop" should really mean for a working physician, why model cards solve procurement but not the fifteen-minute exam room, and what CHAI is doing to finally connect AI performance to real clinical outcomes. What You'll Learn What CHAI's model cards actually tell a physician, and the gap that still exists between hospital procurement and the exam roomThe details of CHAI's new partnership with OpenAI and Anthropic, and what it means for public health agencies gaining free access to Claude and ChatGPTWhy CHAI is bringing a health sector version of Anthropic's Project Glasswing to hospitals, the most attacked critical infrastructure sector in the countryHow CHAI plans to measure whether AI tools are actually improving patient outcomes, not just getting deployed 🩺 Offcall is more than a platform — it’s a community. Join today! 📝 For a full transcript of this episode click HERE 🎧 Subscribe to receive new How I Doctor episodes directly in your feed here: https://episodes.fm/1767429315 👨‍⚕️Follow Dr. Graham Walker on LinkedIn https://www.linkedin.com/in/graham-walker-md/ IG https://www.instagram.com/ubergraham/ Bluesky https://bsky.app/profile/drgrahamwalker.com ✉️ Join our newsletter On/Offcall here https://offcall.beehiiv.com/subscribe 🟧 Follow Offcall on LinkedIn https://www.linkedin.com/company/joinoffcall/ IG https://www.instagram.com/offcalldotcom/ TikTok https://www.tiktok.com/@offcalldotcom

    What Does Good AI in Healthcare Look Like? CHAI CEO Brian Anderson Is Trying to Get Every Hospital in America to Agree
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About

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. If you enjoy the show, please hit the follow button! That will help us continue to bring you more great episodes every week. And don’t forget to sign up for Offcall. Join the growing movement! Offcall: https://www.offcall.com/ LI: https://www.linkedin.com/company/joinoffcall TikTok: https://www.tiktok.com/@offcalldotcom IG: https://www.instagram.com/offcalldotcom/

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