Rishi Khakhkhar

Vibe shift: over the past few months, basically every computer in the community ER where I work has an @EvidenceOpen window up. Younger and older attendings alike. Huge usage everywhere.

Agree that we need malpractice/liability frameworks, but this has been done before (Waymo etc), I think we can solve that problem with the actuaries. Doctronic’s recent jailbreaking/prompt-injection incident raises the more pressing question of whether the states should be regulating this vs the feds. Should the bandwidth-constrained Dept of Commerce in Utah have been responsible for redteaming efforts? That seems unreasonable.

@tqlemd @Joshuabrowder I agree with this and you're already seeing versions of this template in Utah with doctronic (re med mal insurance)

My wife asked to schedule an appointment with her PCP and got a slot in March...2027.

The house of medicine is at a crossroads, I think the path forward is obvious

@dvasishtha We did this before! We villainized “Dr. Google” for 25 years and put our heads in the sand instead of building for the obvious access point of this century. AI care is coming, with or without us. We can help build it safely or accept the acceleration of our fading relevance.

If you as a physician do not believe AI should provide medical advice, here are a few things you should be advocating to the AMA and your local reps for to solve patient access issues: 1. Expand the federal residency cap - we've only added 1,000 residency spots since 1997 2. Fund more GME programs in community and rural hospitals 3. Expand pathways for international medical graduates and unmatched MDs 4. Support team-based care that extends physician capacity via NPs and PAs increasing scope of practice

@dvasishtha I think the same entities that oppose midlevel scope expansion will oppose AI doctors, for the same economic reasons :) That being said I do think AI doctors will be more rigorously scrutinized, evaluated, etc than current midlevel training programs and areas of scope expansion

If you believe that we're going to have AI doctors in the near to medium term future then shouldn't you also believe we can extend greater scope of medicine to physician assistants and nurse practitioners? Or that they'll have bespoke copilots to support expansion of scope.

@shyamalanadkat Go get em!

on the other side this time. different lens. same obsession with making AI useful.

@MarioATX_MD I see. Does the equation change now that the tech is more mature? We’re not there yet but feels very feasible that soon, a capable humanoid robot will be as good as a home health aide or hospital PCA for many use cases.

@khakrish Yeah, theoretically it makes a lot of sense. However, when you learn the real model for a lot of the leading caregiver services and even the facilities they partner with you’ll see that they don’t really care about the tech. It’s all about who will pay and how they get paid.

With MA crashing and Medicaid losing funding #1 is still not solved.

@RobertHermanMD @HenrytTimothy @JACCJournals @smithECGBlog @PendellM @belmontemarta1 Congratulations!

Queen of Hearts AI-based ECG analysis significantly improved STEMI detection, reduced false activations, and enhanced recognition of non-conventional presentations. Just presented by @HenrytTimothy and simultaneously published in @JACCJournals! #TCT2025

@dvasishtha Is it really Big Sean? Sign of a bull market

Excited to discuss how AI can support our neediest Medicaid beneficiaries from a bottle service table at the Big Sean concert this week! #HLTH2025

@CounselHealth is a full-stack, AI-native medical group that makes medical care abundant - unlimited guidance from real doctors, 24/7, scaled by Counsel’s medical AI, in a now familiar chat interface. This system embodies the qualities that everyone should expect from "AI as a New Site of Care", which go far beyond the simplistic, early models of digital health that simply replicated offline visits on a computer screen - e.g. care that is always on, with pan-specialty intelligence, personalized, and exponentially scalable. Thrilled to have led the Seed and be co-leading the Series A with our friends at @GVteam as Counsel launches to the general public. Counsel has served over 100,000 patients through B2B2C partnerships to date, and now everyone can have a doctor in their pocket. Congrats to @malagappan and the whole Counsel team on the launch!

Over 100 million people in the US are without a dedicated doctor. But it shouldn't have to be that way. The technology to scale medical advice exists today. I’m proud that @a16z is doubling down to co-lead @CounselHealth’s Series A alongside our friends at @GVteam. On top of that, Counsel's medical AI is now available to anyone. Our healthcare system is designed to ration access to our scarcest resource – doctor time. And in a world where clinician capacity is scarce, people are forced to turn to Google or ChatGPT for answers. Consumers ultimately need clinical resolution: the prescription, the lab test, the specialist appointment, the follow-up, the ongoing guidance and encouragement to change their lifestyle. Counsel is building healthcare abundance for the AI era. We led Counsel’s seed financing last year because of our conviction in this bold idea: that we can build a world in which everyone has their own doctor for life. They’ve seen immense progress under the leadership of @malagappan, who was previously a Stanford-trained physician, AI researcher, and healthtech executive. I’m delighted to expand our support as Counsel redefines how we access healthcare. @julesyoo @a16zBioHealth

Today we’re launching @CounselHealth to the general public. We believe Counsel is the most advanced combination of medical AI and human doctors in a single interface, and the easiest way to go from “I need advice” to “I’m getting care,” all from your phone. Learn more about Counsel ⏬

I joined the club this year, but wouldn't have made it into the 2024 count 🙂. I look at a lot of applications for our virtualist roles and feel like I've seen 50+ 51ers myself. There are also training programs like airphysicianacademy.com that churn out 50-100 of these every 6 months or so, and that's just one program. I would guess the count is off by an order of magnitude or so; I think it's still fairly rare, but I'd believe a number in the single-digit thousands based on pure vibes.

@khakrish @chrissyfarr Does seem a little low, that’s what was surprising to me. But I guess how many docs do you know with 50 active state licenses currently?

Great recent post by @chrissyfarr in her newsletter about the state of digital health. Here's a stat that stuck out to me: "In 2016, only nine doctors were licensed to practice in all states. In 2024, 172 were licensed in all 50 states, and 356 had acquired at least 45 licenses." This is one of the things that makes @join_velocity different. We are with you every step of the way, no matter where in the country you live. This should be the new normal. Didn't realize I/we were part of the < 0.04% of licensed physicians (>1m in US) that had this broad licensure.

@arakharazian @CounselHealth And we’d love to chat!

@arakharazian At @CounselHealth, we’re democratizing medical advice. We’re building AI-first, doctor-in-the-loop medical care to multiply the most scarce resource in healthcare: clinical capacity.

Who is building the most exciting, tech-forward, company in the health care sector? I want to write about you for my substack.

@BenSchwartz_MD @nikillinit Chekhov’s MRI

@nikillinit Schrödinger’s MRI

I’d like a full body MRI but don’t tell me any of the results. Keep it in a lock box, but when I get my next MRI for an actual issue use it as a baseline for comparison.

@JayRughani Working on it

Excited for the version of this slide on AI doctors

@DrDeepMD Genuinely curious - what do you mean? I always thought the mechanism was that even if the ads sway a small percentage of patients, the manufacturers add enough revenue to make the ads ROI-positive

Pharma companies advertising is not about the content, no one is coming to us docs saying they heard about a med on TV. And they already do list out a ridiculous # of adverse effects Pharma buying tv spots is about exerting control over media reporting