Medicine is full of people doing the right thing inside systems that reward the wrong work.

In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Dr. Shikha Jain, a hematologist-oncologist, professor, and founder of Women in Medicine, to discuss why some of the most essential work in medicine happens after hours, off the clock, and without recognition - especially for women physicians.

Shikha makes a clear case for why physician distress isn’t a resilience problem, a time-management issue, or a pipeline failure. It’s a systems problem. From RVU-based compensation models that ignore invisible labor, to unpaid committee work that never counts toward promotion, to insurance barriers that put doctors in the crosshairs while profits flow elsewhere, she explains how modern healthcare quietly extracts more from physicians while valuing them less.

Together, Graham and Shikha explore how gender expectations shape leadership, why women physicians are “voluntold” into uncompensated work, and how stereotypes around empathy and agreeableness create double standards that follow doctors from the clinic to the boardroom.

The conversation closes with practical guidance for change: how physicians can set boundaries without guilt, how institutions can measure the work that actually matters, and how male allies can show up in ways that help rather than harm.

This episode isn’t about blaming individuals. It’s about fixing the system so doctors can keep doing the work that brought them to medicine in the first place.

1. Why physician burnout is a structural failure, not a personal one
2. How RVU-based compensation undervalues real clinical and cognitive work
3. The hidden, uncompensated labor disproportionately carried by women physicians
4. Practical ways physicians and allies can drive meaningful change

1. Dr. Shikha Jain: https://shikhajainmd.com
2. Women in Medicine: https://www.wimedicine.org
3. Women in Medicine Summit September 24-26, 2026: https://www.wimedicine.org/summit
4. Oncology Overdrive Podcast: https://oncologyoverdrive.com

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Tim Peck has spent his career practicing medicine where the system is most fragile. A Harvard-trained emergency physician, healthcare entrepreneur, and frontline clinician in rural America, Tim has worked inside nursing homes, healthcare deserts, and communities shaped by the opioid crisis—places where delays, payment failures, and policy decisions have immediate consequences.

In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Tim to explore what emergency medicine teaches about leadership, systems failure, and responsibility beyond the bedside. Tim shares why ER doctors are uniquely trained to lead in chaos, how seeing patients too late distorts outcomes, and what he learned by embedding himself in the environments that generate avoidable hospitalizations.

The conversation moves beyond ideology into the mechanics of why U.S. healthcare breaks down—from fee-for-service incentives and uninsured rural populations to ambulance shortages and hospital closures that happen quietly, then all at once.

This is not a political debate or a campaign pitch. It’s a clinician’s diagnosis of a system under strain—and a candid discussion of what it would take to fix it.

1. Why emergency medicine is one of the most effective forms of leadership training
2. What changes when doctors see patients earlier instead of downstream in crisis
3. How rural healthcare deserts form—and what they look like in real time
4. Why nursing homes and opioid care expose the deepest system failures
5. How payment models shape clinical behavior more than most physicians realize

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📝 For a full transcript of this episode click HERE

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Eve Cunningham has spent her career navigating the hard edges of modern medicine from delivering babies and performing gynecologic surgery to leading large health system initiatives and now serving as Chief Medical Officer at Cadence. Along the way, she’s seen firsthand why chronic disease care continues to fail patients despite more data, more technology, and more dashboards than ever before.

In this episode of How I Doctor, Graham Walker sits down with Eve to unpack why clinic-based, episodic care is fundamentally mismatched to conditions like heart failure, diabetes, and hypertension. She explains why early efforts at remote patient monitoring fell flat, how change management and not technology has always been the real barrier, and why most health systems struggle to turn insight into action.

The conversation moves from the realities of governance-heavy decision-making and physician burnout to what it actually takes to manage patients upstream before they land back in the ICU. Eve also shares the deeply personal connection that drives her work, including how her father’s experience with chronic illness shaped her view of what patients truly need.

This is not a tech demo or a sales pitch. It’s a candid discussion about redesigning chronic disease care in a way that works for patients, clinicians, and the realities of modern medicine.

1. Why episodic, visit-based medicine is structurally incapable of managing chronic disease
2. What early remote patient monitoring efforts got wrong and what has finally made them work
3. How change management and incentives matter more than technology alone
4. Why health systems struggle to act on data, even when the answers are obvious
5. What proactive, upstream care looks like when someone is actually accountable

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David Rhew has spent his career at the intersection of frontline medicine and cutting-edge technology. An infectious disease physician by training and now Global Chief Medical Officer at Microsoft, David brings a rare perspective shaped by decades of clinical work, health system leadership, and early research on AI in healthcare.

In this episode of How I Doctor, Graham Walker sits down with David to unpack where AI in medicine is actually headed and why so many clinicians feel frustrated despite using these tools every day. David explains why physicians aren’t afraid of AI itself, but of poorly designed systems that remove judgment, overload workflows, and fail to reflect how medicine really works.

From agentic AI and ambient documentation to population screening, risk stratification, and resource allocation, the conversation moves beyond buzzwords into the real mechanics of how AI can support better care.

David makes the case that AI’s true promise is helping clinicians practice at the top of their license, identify disease earlier, and redesign care around human decision-making rather than administrative burden.

This is not a futurist thought experiment or a vendor pitch. It’s a grounded, systems-level look at how AI could meaningfully improve medicine.

Explore the Data

📊 Want to see how your peers are actually using AI today? Download Offcall’s 2025 Physicians AI Report, featuring insights from over 1,000 physicians on daily AI use, adoption gaps, and what doctors really want from these tools:

👉 https://2025-physicians-ai-report.offcall.com/

1. Why the biggest failure of healthcare AI isn’t the technology itself, but how it’s measured, implemented, and governed
2. How agentic AI with multiple models working together on discrete tasks can outperform single “super models” in complex clinical problems
3. Why ambient documentation succeeded by addressing burnout and patient experience, not productivity metrics
4. How AI-enabled screening and risk stratification can identify high-risk patients long before symptoms appear
5. What skills physicians will need in the next decade to apply AI responsibly without losing clinical judgment

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📝 For a full transcript of this episode click HERE

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Merry Christmas! Today we are re-releasing one of our favorite episode of the year. We'll be back next week with a brand new interview to kickoff 2026.

Mark Cuban is a business mogul, the “Shark” every entrepreneur wants to make a deal with, the former owner of the Dallas Mavericks, and, most recently, an online pharmacy CEO. In 2022, Mark co-founded Cost Plus Drugs with the goal of lowering prescription drug prices. The direct-to-consumer company makes generic drugs affordable by cutting pharmacy benefit managers out of the distribution chain. But, once Mark starts talking about tackling the pharmaceutical market, you get the sense he has his sights set on an even bigger goal: reforming the healthcare system at large.

Offcall co-founder Graham Walker recently got the chance to interview Mark on How I Doctor, a podcast that explores the lives and careers of physicians who are practicing medicine differently. Mark, of course, is not a physician. But, as Graham notes, “I'm talking to him because I think he actually gives a damn about healthcare, and more importantly, he's doing something about it.”

Mark pulls no punches in this episode, and frames American healthcare as a David- and Goliath-style fight between good and bad actors.

Physicians are on the good team: “I happen to be a fan of people who save lives and make other people feel better, you know? Call me crazy.”

Who’s on the bad team? Anyone trying to game the system and extract money from it for their own benefit — insurance companies, hospitals, private equity firms, and others. “In healthcare, that $4.9 trillion wherever anybody can arbitrage whatever they can out of the system, that's exactly what they are going to do.”

With clarity of conviction and a hard-charging spirit, Mark shares his vision for how to fix healthcare.

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https://www.offcall.com/

For a full transcript of this episode click HERE

https://www.offcall.com/learn/podcast/mark-cuban-interview-how-shark-tank-star-and-cost-plus-drugs-ceo-would-fix-healthcare

Find all episodes of How I Doctor at offcall.com/podcast or subscribe on your favorite podcast player at https://episodes.fm/1767429315.

In this episode, Graham and Mark discuss:

04:26 Expanding Medical School Enrollment

09:33 Insurance Plan Designs

16:27 Insurance Company Tactics

20:45 Negotiation Loopholes and Legal Tangles

28:04 Healthcare Spending

34:53 Transparency and Trust Drive Growth

43:37 Unfair Broker Fees

49:53 Profitability in Specialized Medical Services

55:08 Future of AI-Assisted Healthcare

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Dr. Eric Topol is one of the most influential voices in modern medicine. Founder of the Scripps Research Translational Institute and author of Deep Medicine and Super Agers, Eric has spent decades interrogating medical dogma, calling out hype, and pushing the profession toward evidence, prevention, and humanity.

Dr. Graham Walker sits down with Eric for a candid conversation about why physicians shouldn’t fear AI and why when used correctly, it may be one of the most powerful tools we’ve ever had to reduce errors, restore trust, and shift medicine from late-stage treatment to true prevention.

From diagnostic error and physician burnout to immune aging, GLP-1s, personalized risk prediction, and the limits of randomized trials, this episode is both a reality check and a roadmap. Eric makes the case that AI’s greatest promise isn’t automation, but rather it’s the ability to see what humans never could, identify risk earlier, and finally decouple aging from chronic disease.

This isn’t a hype cycle conversation. It’s a grounded, evidence-based look at how AI could help fix what’s broken in medicine if physicians lead the way.

Explore the Data

📊 Want to see how your peers are actually using AI today? Download Offcall’s 2025 Physicians AI Report, featuring insights from over 1,000 physicians on daily AI use, adoption gaps, and what doctors really want from these tools:

👉 https://2025-physicians-ai-report.offcall.com/

What You’ll Learn

• Why Eric Topol believes doctors shouldn’t fear AI and why holding it to an impossible standard may be harming patients
• How AI could dramatically reduce diagnostic error and support better clinical judgment
• Why prevention has failed historically and how AI finally makes it possible at scale
• The difference between AI hype and evidence-backed breakthroughs physicians should actually care about
• How personalized, data-rich medicine may reshape trials, training, and the future role of the physician

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📝 For a full transcript of this episode click HERE

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AI is already shaping how physicians practice. And for the release of The 2025 Physicians AI Report, Graham is taking a different kind of episode: a deep-dive mailbag where he answers the questions doctors are actually asking about AI, grounded in one of the largest physician surveys of its kind.

More than 1,000 physicians were polled in this project, and their answers paint a far more nuanced picture than the headlines suggest.

📊 Yes, two-thirds of physicians already use AI every day.

✅ Yes, the majority believe AI can meaningfully reduce administrative burden.

⚠️ And yes, 81% are frustrated with how their organizations are deploying it.

In this episode, Graham walks through those realities one by one.

He breaks down why doctors trust AI for documentation but hesitate when it comes to decision support. Why the #1 fear isn’t “AI will replace me,” but rather who will control it. How payers, administrators, and mixed incentives shape the way AI enters clinical workflows. And why physicians may quietly be years ahead of their institutions in actually using the technology day-to-day.

He also shares the moments from the report that surprised him most and the “dream tools” physicians wish someone would build already. And he offers a roadmap for healthcare leaders, AI companies, and clinicians about how to prevent AI from becoming the next EHR rollout: deployed to doctors instead of with them.

👉 If you want to go deeper, you can download the full dataset and insights in The 2025 Physicians AI Report at https://2025-physicians-ai-report.offcall.com/

Whether you’re experimenting with AI every shift or still cautiously watching from the sidelines, this episode offers clarity on where physicians actually stand and where medicine is headed next.

• What doctors are really doing with AI right now Two-thirds of physicians already use AI daily, but what exactly are they using it for, and how are they integrating it into their clinical workflows?
• Why organizational deployment is failing physicians From restrictive policies to unclear guidelines, Graham explains why 81% of doctors are frustrated and what leaders must fix to avoid repeating the mistakes of the EHR era.
• The #1 fear doctors have about AI and it’s not job loss Physicians overwhelmingly worry about AI falling under payer and administrative control. Graham breaks down the incentives behind that fear.
• What physicians want from AI companies A clear message to builders: specialty matters. Physicians don’t want “AI for doctors”; they want tools that understand their specific workflows.
• Why AI adoption is happening with or without institutions Graham explains how grassroots physician use is outpacing formal hospital adoption and what that means for the future of medical practice.
• Access all findings from The 2025 Physicians AI Report Download the full report, charts, and analysis at https://2025-physicians-ai-report.offcall.com/

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📝 For a full transcript of this episode click HERE

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Independent primary care isn’t a relic of the past — it’s becoming the future of American medicine.

In this episode of How I Doctor, Dr. Graham Walker talks with two leaders helping drive that shift: Dr. Umar Bowers, an internist who left a major health system to build the practice he always envisioned, and Dan Bowles, General Manager of Practice Health at Aledade , the physician-led company enabling thousands of doctors to stay independent, financially stable, and clinically autonomous.

Umar shares his personal journey from rising frustration inside a large employed medical group to opening Dawson Medical Group with the support of Aledade. He explains what independence really means, why he had zero fear stepping out of the system, and how value-based care became the engine that allowed his practice to thrive. You can read more of his story in Aledade’s physician success profile or connect with him directly on LinkedIn.

Dan offers a rare inside look at why so many doctors feel trapped in employment, what’s driving the national shift back toward physician-led care, and how Aledade’s data, contracting expertise, and ready-made community of independent clinicians help doctors cross the bridge to autonomy instead of trying to swim it alone.

This isn’t another story about burnout or bureaucracy, it’s a roadmap for physicians who want their careers, their schedules, and their practices back. Whether you’re considering independent practice or simply want to understand the movement reshaping primary care, this episode shows how doctors are taking back control of the profession, one practice at a time.

• Why independent primary care is resurging and how value-based care is creating new financial stability for small practices.
• How Dr. Umar Bowers built his own practice from scratch and why he had zero fear leaving a major health system.
• What Aledade’s turnkey model actually provides, from startup capital and contracting support to data, workflows, and a nationwide physician community.
• How doctors can reclaim autonomy, flexibility, and clinical decision-making power without sacrificing income, infrastructure, or patient care.
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