How I Doctor with Dr. Graham Walker

A few weeks ago, Graham sat down with Dr. Wendy Dean, co-founder of Moral Injury in Healthcare, for one of his favorite conversations this show has ever recorded. It's the kind of episode that changes how you talk about your own job. That's why this week, How I Doctor is doing something new: handing the feed over to Wendy's own show, 43cc, which she co-hosts with orthopedic surgeon Dr. Matt Ramsey. 43cc bills itself as informal, informative, and irreverent, and if this episode is representative, that's undersold. It's the conversation you'd have with a colleague after a brutal clinic day, if you let yourself say the quiet part out loud.In this episode, Wendy and Matt start from a real patient encounter, a $3,100 out-of-pocket shoulder MRI on a $6,500 deductible, and use it to walk through exactly how the system got this expensive and this hard to fix from the inside. They don't stop at diagnosing the problem. They name the specific legislative mechanism (a provision buried in the Affordable Care Act) that keeps physicians from building an alternative, and the bills currently in Congress trying to undo it.What You'll Learn in This Episode:Why one patient's $3,100 out of pocket MRI charge reveals exactly how high deductible plans are designed to work against patients, not for themThe real difference between concierge medicine and direct primary care, and why Wendy argues only one of them actually changes the underlying cost of careHow Section 6001 of the Affordable Care Act froze the growth of physician owned hospitals in 2010, and why reversing it has become one of the more promising paths to real competition in healthcareWhy employer sponsored health plans, not federal legislation, may be the most realistic lever for forcing change in how insurers and hospitals operateSubscribe to 43cc wherever you get your podcasts to hear more from Wendy Dean and Matt Ramsey. Full episode and show notes here: 43ccpodcast.com🩺 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 onLinkedIn 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

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 deskillingWhat 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 gaspHow 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 statusWhether medicine can still be a calling after the system has spent years turning it into a job🩺 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 onLinkedIn 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

Physicians are making more correcting medical misinformation online than delivering babies.In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Dr. Fran Haydanek, better known to millions as Paging Dr. Fran, for an unfiltered conversation about medicine in the algorithm era.Fran is a board-certified OB-GYN, residency faculty member, hospital medical director and a physician creator with more than one million followers across TikTok and Instagram. What began as a simple video correcting breastfeeding misinformation during maternity leave has evolved into a full-scale media operation. One that now generates more income than her clinical practice.But this episode isn’t about clicks. It’s about trust.Together, Graham and Fran examine why patients increasingly turn to influencers instead of physicians and why the medical system itself helped create that vacuum. Fran argues that physicians don’t just compete in this digital ecosystem and that they have an obligation to show up in it.This episode isn’t a defense of influencer culture.It’s a reckoning with where patients actually learn about their health and whether physicians are willing to meet them there.What You’ll LearnWhy patients are turning to TikTok for medical advice and how 15-minute visits contribute to the problemWhat it means for medicine when a practicing OB-GYN earns more correcting misinformation than delivering babiesHow religion and politics uniquely fuel misinformation in women’s healthPractical ways any physician can participate in the digital information ecosystemResources & Where to Find Dr. FranWebsite: https://www.pagingdrfran.com/TikTok: https://www.tiktok.com/@pagingdrfranInstagram: https://www.instagram.com/pagingdrfran

Primary care sits at the center of medicine and yet no one seems willing to truly own it.In this episode of How I Doctor, Offcall co-founder Dr. Graham Walker sits down with Lisa Rosenbaum, cardiologist and national correspondent for the New England Journal of Medicine, for a wide-ranging conversation about why primary care remains both indispensable and persistently undervalued.🎧 Before you go any further: If this conversation resonates, make sure you also listen to Lisa’s excellent NEJM podcast, Not Otherwise Specified. It’s one of the most honest, intellectually rigorous explorations of modern medicine and this past season focuses deeply on primary care.Lisa has spent the past year reporting on primary care across the country, and what she uncovers isn’t a story about technology gaps or workforce shortages. It’s a story about culture. About respect. About responsibility. Together, Graham and Lisa explore how modern incentives have quietly shifted medicine away from ownership - of patients, of decisions, and of outcomes - and why primary care has absorbed the consequences more than any other specialty.They dig into uncomfortable but essential questions:Why is the specialty that knows patients best paid and respected the least?How did “referral culture” replace continuity?And what happens to trust between doctors, and between doctors and patients when no one is clearly responsible anymore?Lisa argues that the crisis in primary care is not inevitable, and not intractable but only if medicine is willing to confront its own values.This episode isn’t about nostalgia.It’s about deciding what kind of profession medicine wants to be.What You’ll LearnWhy the crisis in primary care is fundamentally about respect and ownership, not technologyHow modern systems discourage physicians from fully “owning” their patientsThe hidden costs of referral culture and fragmented responsibilityWhy restoring autonomy may be essential to saving primary careWhat gives Lisa hope—and why cultural change is still possible in medicineResources & Where to Find LisaLisa Rosenbaum, MD – National Correspondent, New England Journal of MedicineNot Otherwise Specified (NEJM Podcast)🩺 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 onLinkedIn 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 onLinkedIn https://www.linkedin.com/company/joinoffcall/IG https://www.instagram.com/offcalldotcom/TikTok https://www.tiktok.com/@offcalldotcom

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.What You’ll LearnWhy physician burnout is a structural failure, not a personal oneHow RVU-based compensation undervalues real clinical and cognitive workThe hidden, uncompensated labor disproportionately carried by women physiciansPractical ways physicians and allies can drive meaningful changeLearn More About Shikha & Women in MedicineDr. Shikha Jain: https://shikhajainmd.comWomen in Medicine: https://www.wimedicine.orgWomen in Medicine Summit September 24-26, 2026: https://www.wimedicine.org/summitOncology Overdrive Podcast: https://oncologyoverdrive.com🩺 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 onLinkedIn 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