In this thoughtful conversation with Dr. Hiba Hamdar on , we discussed where AI already outperforms doctors, where it still falls short, and what medicine risks losing if it leans on AI too soon.

As a radiologist, I spend the majority of my time in clinical practice. Much of my work sits at the intersection of daily clinical practice and the AI tools increasingly built into it. Alongside my clinical work, I serve as a consultant and reader on clinical trials evaluating AI software for radiology applications, as well as trials for oncology drugs in development. I’m also the founder of Physician Vantage Studio, a venture focused on helping physicians navigate career architecture - helping them create leveraged, flexible, and fulfilling careers without leaving medicine.

What follows is a wide-ranging conversation about where AI already quietly runs in the background of medicine, where it still needs a human to catch what it misses, and what’s at stake - for patients, for students, and for the profession - as that balance keeps shifting.

- Scott F. Cameron, MD and Hiba Hamdar, MD

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The Conversation

Hiba: To start, can you tell us a bit about your background and the work you do day-to-day?

Scott: Sure, so I’m a practicing radiologist at Atrius Health, and I work in the Greater Boston area, and I practice clinically the majority of the time. I also spend some time working as a consultant and participant on clinical trials, where I’ve had experience reading for AI trials, for AI software and development, particularly for radiology applications. I also read for clinical trials for oncology drugs that are in development. And then I also have an entrepreneurial venture where I’m working on Physician Vantage Studio, which is a business around helping physicians with career architecture. So that’s what I do in a nutshell.

AI has actually been used in medicine for decades - even thirty or forty years ago - though it wasn’t always recognized as AI. How was it being used back then, and how did doctors even know they were using it?

Yeah, so it’s interesting. As you said, AI has been around for a long time. So in radiology specifically, we’ve had computer-aided detection, or CAD, for mammography for a long time - for over a decade, much longer than that. And it was really embedded as part of the workflow where, for example, you’re reading mammograms, and then at the end of your review of the case, you would press a button and then it would flash sort of an indicator on the screen telling you what the AI detected or didn’t detect. So it was a little bit subtle, a little bit in the background - you had to trigger it to make it appear. And I think now it’s interesting because we have very many more AI solutions, and some of those are truly hidden into the background and you don’t see them. Some of those may be workflow solutions. So, for example, let’s say a triage AI algorithm, which basically looks through the cases that you have to read on your list, and it will automatically detect which one of those cases should be brought to your attention earlier for review, and it will shuffle those up in the list so that you can see them. So an example would be if you had a list of CT scans, and one of these CT scans had an intracranial bleed, you’d want to know about that sooner than later. And so the software in the background could pick that up and then bump it up on your list. And then you know, okay, this is the next one I need to read, without you having to interact and do anything. So those are some solutions that are really kind of quietly running in the background. And then you have some more solutions that are more visible and require more interacting with. A lot of those tend to be the diagnostic tools as opposed to the workflow adjunct tools. And so those may be, for example, an AI software that is helping to characterize a particular tissue or tumor type. And you’re going to click on that part of the image and it’s going to analyze it, give you some output, and then you have to look at that and then review it in the context of the patient’s medical record to decide how useful it’s going to be in your decision making. So it really spans the whole range, from being completely invisible and in the background to being something that you’re really interacting with quite a bit.

Could AI ever replace a human doctor?

Yeah, that’s a very popular question. I think the real answer to that is we don’t know. I think that a lot of people see the power for AI solutions and software. I don’t envision AI replacing the human anytime soon. I think it’s going to really be an adjunct to healthcare delivery, and we’re going to work collaboratively with AI. I see AI as having a lot of power in streamlining a lot of the processes that we do, eliminating a lot of the mundane routine tasks that we do - let’s say documentation, or measurement of certain lesions on imaging studies, things like that. And I also see it potentially taking care of a number of examinations or encounters that are either normal or close to normal. And so, in that way, handle some sort of simpler cases. But I think those more complex cases, or the cases that require more context and judgment, still will need the human element. But I think ultimately we have to maintain a sense of humility and say that we don’t really know fully what’s around the corner five years, ten years, fifteen years from now.

A recent Forbes article suggested AI will likely beat doctors at key medical tasks. Based on your experience, what does AI have that human doctors don’t - and what do doctors have that AI doesn’t?

Sure. I haven’t read that article that you’re referring to, but I think what they’re kind of getting at is: if you look at a particular task or a narrow domain, can AI outperform a human? And I think we have data that the evidence is yes, for certain instances of those types of things. So if you take a particular narrow use case, I think AI can have a lot of power there, potentially be better than a human, depending upon the scope of what it’s trying to do. I think what AI has, really, that humans do not have, is that the AI has access to a lot more resources. It has access to an almost infinite amount of data and computing power, whereas the human mind, as smart as it is and as complex as it is, has a limited ability to process things, from an information processing standpoint. AI just doesn’t have those limitations. So it can draw on a much larger pool of knowledge, it can run essentially all of the time, and it doesn’t fatigue. It doesn’t ask for breaks, it doesn’t get emotionally attached to the task that it’s doing. And so, from those respects, I think AI has an advantage. I think where AI falls short is that it doesn’t have the full clinical context that humans have when they are taking a patient under their care. So AI has a lot of advantage when it comes to content, but not necessarily context. And so the human really has that advantage there, because you’ve had the years of experience seeing the subtleties and the nuances in how patients present in different ways, how they present in imperfect conditions, and what to do when you see those sort of complex scenarios. AI may not always have that sort of ability to handle those contexts, but it may perform very well under certain predefined scenarios A, B, C. So I think that’s where humans have the advantage. And then also, humans have empathy and have connection, and I think that’s hard for AI right now to replicate. And I think that can drive certain behaviors and compliance from the patient side, because if you think of a patient as consuming healthcare services, you ultimately want the patient to do something with that. And so if you want the patient to get a follow-up scan, or take a medication, or start a lifestyle intervention, there has to be that trust and that compliance that’s going to come after you give them that information. And I think humans do a pretty good job of helping the patient understand what they need to do and encouraging them to do that. Whereas I’m not quite sure AI is going to have that same longitudinal impact and relationship and follow-up. But I think time will tell. These tools are getting better and better all the time, and so it remains to be seen.

Human medical critical thinking - the ability to diagnose, analyze, and reason through a case - is such an important skill. Do you think AI could eventually replicate that kind of critical thinking?

So I think there is some data to show that it can be superior to human thinking in certain contexts, given certain tasks. So the answer is yes, as far as that goes. But the caveat is that those studies and that data have been generated under certain conditions, and those conditions are not always true within real-world clinical scenarios. And so I think we need to gather more data, do more studies, and find out how this generalizes across a patient population and different presentations. And so that gets back to what I said earlier, where if you look at a specific instance or specific question, it can work as good or better than a human, but when you try to generalize it or extrapolate across a wider patient panel, I don’t think it holds up, at least right now. So that’s sort of where we are.

Anyone today can build an AI tool, but many of them produce unreliable or completely wrong results. From a physician’s perspective, what does it actually take to build a successful, working AI tool?

So I think for working tools, I would first start with the problem that’s trying to be solved. So the person that’s creating that tool has to be very clear about what is the problem, and what do I think is the potential solution for the problem. And so, once you have that problem identified, then it’s a matter of saying, okay, who are the people that really know this problem well, and how can I get information from those people to inform the solution that I’m building. So I think that’s where I would start from. And then, once you have that information, it’s a matter of developing a working prototype or something that you can sort of beta test and get some feedback on, and find out is this something that could potentially solve the problem, and what is it going to take to improve upon this and get it better. If it’s a technology solution, you might need to really enlist the help of experts to create that, because it’s true that we have a lot of tools at our fingertips in terms of making AI apps or making websites, all these kinds of things, but at the end of the day, the more robust that tool is, and the more it’s going to integrate within a healthcare workflow, the more you have to really weave in other experts - whether that’s IT experts or a true software engineer or coder - to get that product to really work well. And then you have to go through the steps of plugging it into the healthcare IT infrastructure to get that tool to work well. And that’s not always easy to do, or a smooth process, because to get something to sort of be tried out in a real clinical context takes a lot of regulatory approvals and committee approvals before you can actually try it.

Given how much data AI now has access to, do doctors still believe in the term ‘idiopathic’ - or could AI eventually explain conditions we currently can’t?

That’s interesting - I haven’t thought about that question, nor have I heard it, but I think within the current limitations of the AI tools that we have out there, there still will be things that are idiopathic, that we don’t know what causes. I think the challenge that we have to look out for is that the way these AI tools are trained is that they want to give you an answer, and they want to make you feel happy that you’re continuing to interact with them and ask them a question and solicit feedback or an answer. So there is this temptation for the AI to be biased a little bit in that regard, and to sometimes guess at an answer when it doesn’t know. And I think that’s something that also really distinguishes between AI and the human - we tend to have a much easier time of saying we don’t know, or labeling a condition as idiopathic, whereas the AI may just guess and go out on a limb. And I think that can sometimes be dangerous. So I think that’s where we are at present - that there’s still things that are idiopathic. But whether we get there, let’s say ten years, fifteen years from now, where fewer things are idiopathic and AI can really give us some true answer within some type of confidence interval, remains to be seen. But my guess is that biological processes are so complex that there still will be a subset of cases that even the AI is not able to know, and it’s just going to perhaps be able to narrow it down to a few things - say it could be any one of one, two, three — and then the human has to layer in their judgment and context.

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If a patient tells you they used AI to diagnose themselves, how much do you trust that tool or its results? And if you were the patient, would you rather be diagnosed by AI or by a doctor in the traditional way?

So I suspect that patients will have their own preferences, and that it’s not going to be totally uniform for what they would like. I think from my perspective, I always like patients to be educated and informed. I think it really drives better outcomes when they are coming to the table with an educated perspective, and if the AI tools get them there faster, I’m all for it. What I like is to form my own independent opinion of the case in front of me and the patient in front of me, and then I will consult the AI tool, see what the AI says, and then take that into consideration - but always have the final judgment rest on my shoulders. And I think that a lot of patients would appreciate that as well, because they don’t necessarily think that their doctor’s not doing any thinking or reasoning, just trusting a computer or a software and then going to say what it thinks is the right thing. But at the end of the day, I think it’s really a combination of the AI knowledge and tool and the doctor’s knowledge - it’s just a question of how you want to sequence that. But I think that many physicians, at least the ones that I’ve talked to, are pretty receptive to patients showing up in the clinic having already consulted and talked to Chat GPT or Claude. And so I think that’s fine, and I think they like to think about it as a way to sort of streamline their visits, because the patients are already pre-educated coming into the clinic. Then it’s a matter of the doctor driving the conversation and saying, here’s what I think given the totality of all the information that’s out there. What’s in my brain, what’s in the computer and the AI, and let’s bundle it all together and come up with a diagnosis and treatment plan for you.

How far can AI go wrong, and how far can a human doctor go wrong, when it comes to diagnosing a patient?

So the AI can make mistakes. The AI can certainly hallucinate answers and diagnoses and things like that. I’ve read some cases where unfortunately the AI told a patient to drink a poison, or something like that - really dangerous things. And so I think these tools really have to be taken with a grain of salt. And that’s why, again, I advocate for having a human in the loop, where you’re always sort of passing something by the doctor to make sure that they approve. But the AI can really span the range in terms of what it tells you. And oftentimes it will tell you things that are really beneficial - things that are as good as what the physician would tell you. But it’s really unpredictable how good it’s going to be, and I don’t think we have enough experience yet to say in what cases you can trust it and in what cases you can’t. And then the humans - we have our limitations, of course, also. We’re not perfect, and we have certain biases that we can be susceptible to. But I like to think of the AI as being something of a safety check, or a double check, or a second set of eyes that can hopefully help take away some of those biases, or resurface some things that we hadn’t considered or thought of. And then we say, wait a minute, I missed this, or I was wrong because of XYZ, and the AI reminded me of that, and now I can go ahead and make the right diagnosis. So the summary statement is that mistakes can occur in either context, but I think if you take all the information together, hopefully you’re decreasing your chances of making a mistake overall.

A professor I spoke with recently said he’s worried that medical students relying too heavily on AI won’t develop strong critical thinking skills. How concerning is that idea to you - and if that’s a risk for students, why do we encourage patients to use AI for their own education?

It’s a great question, and I think it is something that I’m worried about. I’m worried about it because if medical students start to rely too much upon AI early in their journey, they may not develop that core body of knowledge that they need as a physician, because you do need to have a baseline understanding of knowledge to serve as the foundation of your decision making, your judgment, your experience. And the clinical rotations that you have build upon the knowledge that you’ve learned about in your preclinical years. And so if you rely too much upon AI to give you the answer, and you’re not sort of downloading that knowledge into your brain, you’re missing that part of it. And then also, if you rely too much upon it to give you answers, you may lose your ability to do critical thinking, as you said. And also communication, right? Because communication skills are built through talking with other students, talking with teachers, talking with patients. And if you rely too much upon the interface electronically, that part of it may atrophy as well. And so if you lose some of that knowledge, you lose some of the critical thinking ability, then you’re just going to become too dependent upon the technology, and you’re not going to be able to really provide those guardrails and those safety rails for patient care down the line when you’re actually seeing patients. And I think that can be extrapolated to many things in day-to-day life, not just clinical care. But if you use AI too much, then your ability to think independently and critically could atrophy away. So I am concerned about that - like, how are people going to approach it and use it? And so I would hope that in medical education, we’re still emphasizing the rigorous way of training that we have been in the past, but that we sort of implement AI education on top of it, so that people learn how to use these tools smartly and judiciously at the right time, without over-relying on them.

If a doctor uses AI to design a study and generate the results, how much can we trust those results - and who deserves the credit, the doctor or the AI?

It’s a good question. I’m not quite sure, because there’s certainly a lot of attention being paid right now towards how to augment clinical trials with either virtual patients or simulated patients, and generate data that way. But I think we have to look at it in a new way of human working hand in hand with the AI. And we have to be transparent about how the research was done, what role the AI played in the research. And I think if the AI helps to accelerate the data capture process, I think it’s probably a good thing. But we want to make sure that the AI doesn’t introduce any bias into the study, that all the methods are transparently disclosed, as I mentioned. And I think that the researcher gets the credit, but just acknowledging that the AI was part of that process, and how it was used. But I think the scientific community is going to have to weigh in on that as time goes on. And I know that the peer-reviewed journals that publish these research studies are starting to develop their own criteria for how authors disclose how they used AI in the writing of articles or in the performance of research. And each one of those journals has its own independent discretion for how they do that. But I think the scientific community is going to have to wrestle with these questions as time goes on, because AI is becoming very powerful and can really serve as a good adjunct for these research studies.

If AI can predict and prevent disease, how much do you think it could reduce disease progression overall?

Yeah, that’s something that has a lot of power for AI - preventative medicine. I think that when we think about precision medicine or personalized medicine, and using AI in that application, it can be very powerful, because if you’re able to catch a disease much earlier, of course you can treat that earlier and potentially have better outcomes and decreased morbidity and mortality. I think it has a lot of power to do that. I think, especially in my world with diagnostic imaging, we would love to see a world in which AI combined with medical imaging - for example, screening tools like mammography, or lung cancer screening CT, or even AI-assisted colonoscopies, things like that - where we have augmented our screening technologies and we catch disease earlier in a lot of people and can really have an impact on survival. So I think it’s tough to quantify that right now and say how much of an impact it’s going to have. But I think it will have a pretty significant impact as the technologies get better and better, as they permeate practices more and more. And so I’m very excited about that component - how do we think about screening populations of people more efficiently with AI and catching that disease earlier? And that could also be extrapolated, let’s say, to blood tests - looking at blood markers or genetic markers that predispose people to disease. How can AI be used in those assays and in screening those samples? Those are all very exciting areas of development, and I think we’re going to see a shift towards that as time goes on, because historically we’ve always had reactive medicine, treating the condition once it’s popped up. And I think now the pendulum is going to swing a little bit more towards the preventative side of things, emphasizing catching disease upstream.

AI has been progressing for years, yet we still don’t have proper treatments for cancer and other chronic diseases. Why hasn’t AI had more of an impact there so far?

Yeah, I think a lot of this has to do with the excitement and the hype around AI, contrasted with how long it actually takes for something to have data behind it, and then, once it has data behind it, get approved through the regulatory pathway, and then enter into clinical workflows and have acceptance and clinical adoption. That pathway tends to be pretty long, and so I think that’s part of the reason why it doesn’t feel like it’s as impactful as we think it should be. I think there’s that length of the healthcare life cycle, from the idea or the concept, all the way to implementation in the clinic. And so I think that’s part of it. And I think another part of it is just the expense behind some of these solutions, because it costs a lot of money to do trials and develop this software and things like that. And then it also costs a lot of money to implement that in the practice. And we’re still working on getting reimbursement pathways built to implement a lot of those. And if you don’t have the reimbursement pathway, the question becomes, who’s going to pay for it? Is it going to be the patient paying for the AI? Is it going to be the doctor? Is it going to be the insurance provider, right? And so those things can also limit how that’s adopted in clinical care. And when you limit that, you’re also going to be providing a little bit of a bottleneck around gathering more data around how these technologies work. So I think those things, all combined, just kind of stretch out that timeline for how long it takes until you have the real-world impact that you expect to see.

There’s a real AI gap between developed countries and low- and middle-income countries, and patients in those countries are still suffering from diseases AI has helped address elsewhere. How can the medical community help close that gap?

Yeah, I think that’s a great opportunity for AI to step in and provide some care to these low and middle-income countries. I think a lot of this is going to be facilitated by telemedicine or virtual care, where you have, for example, care provided at low to zero cost to patients that need it in underserved areas - and whether that’s going to be AI augmenting the virtual care, or whether it’s going to be AI serving as the sole medical care, you have to somehow create a construct around that, like what is it going to look like from a liability perspective, from an access perspective. But if you imagine that AI could be good enough, let’s say, to provide care for 80% or 90% of certain patient encounters or routine sort of issues, then you could make that accessible and available to the people in these countries. They could just utilize that and understand that this isn’t a substitute for full-service, bona fide medical care, but it’s at least something, and something is better than nothing to help them at least get some level of understanding of what to do. Or maybe it’s even like a triage thing, where they say, use this software, and if it elevates the risk level of what I’m describing up to a certain point, then I know I need to seek out in-person medical care. And then it’s going to be a matter of how you build that infrastructure around those patient visits, because you have to make sure, of course, you have computers, you have the software, you have the internet access - you have all of those things which would need to be built out. But I think that’s a really exciting extension of the AI wave - how do you create, for example, a virtual AI doctor or chat bot to help out people in underserved communities that really have a strong access issue to healthcare.

You mentioned working on AI triage in clinical trials - how does that actually work?

So what I meant by that was, I do trials where we look at AI software that’s in development. So if you have, for example, a software that wants to detect a lung nodule on a chest CT, they would ask me to evaluate how well that tool is doing at identifying that nodule, measuring it, and reporting it, compared to what I would do. And so that’s how it is - I would say, okay, the software did pretty good here, but here’s how I would adjust its output, and so on and so forth, to try to help that software better approximate what I would do as a physician. No, that’s not the way that I was using it, but I do think there are some companies out there that are looking at some variation of that, where they’re asking how the AI can be layered onto the trial itself and do some of the steps. But I haven’t personally been involved in that particular piece.

• Scott F. Cameron, MD is a practicing radiologist, AI implementation leader, angel investor, and MRS Past President. He writes about physician career architecture at Physician Vantage Studio.

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A physician I know left clinical practice for a digital health company about a year and half ago.

He was hired for his experience and clinical judgment. After about a year in the role, he noticed something nobody had warned him about: his judgement was starting to fade. Meetings that used to lean on his firsthand experience started to feel more difficult.

Colleagues began introducing him as someone who used to practice. Nobody talked about this intellectual fading out loud, but he could feel it.

This essay is about what the practice of medicine actually does *for* us, while we sometimes complain about the hardships and the long hours.

The busy workday, back-to-back patients, administrative burden, prior authorization, and navigating the referral system and insurance pathways are all real - and they all can contribute to a strained day. Many experience the ‘hamster wheel’ production style feeling of medicine - not in all practice types, but in many.

But there’s another aspect of practicing medicine which deserves attention and appreciation - because while the costs of staying in medicine are visible and felt on a daily or weekly basis, the costs of leaving are also there - but they are more subtle and in the background. Those costs show up in a delayed fashion, popping up once the clinical door has closed, months or years later. That asymmetry doesn’t get talked about much in our professional circles, but let’s look closer at what physicians can potentially lose if they leave clinical work behind:

1. Credibility that can’t be replaced elsewhere. “I’m a radiologist deploying clinical AI” and “I used to be a radiologist” have different market weights, and that gap widens every year that goes by. Companies are much more interested in how you actually practice than in your opinion.

2. Real world problem and solution context - the raw material that you don’t get anywhere else. These aren’t hypothetical things that you might encounter, they are things that actually frustrate you and your colleagues. The outside imaging study that didn’t get requested for comparison when it should have, the notes from the technologists worksheet that should have been automatically imported into the EMR that didn’t. Real-world relationships with colleagues, administrative leaders, patients, technologists, and vendors that inform clinical decisions.

3. Reversibility - the thing that makes the experiment the experiment. After all, the bounded career experiment is only safe inasmuch as there’s a career to return back to, a strong foundation from which to build on again. If you remove that clinical anchor, you’re making a bet that doesn’t have a floor. If you keep your practice, you could run nine tests. If you leave it, you might be running one.

4. Cash flow that provides an operating cushion, and a solid ‘fall-back’ plan B. Clinical income doesn’t just keep the lights on, it also gives you that long runway with which to evaluate opportunities carefully instead of hastily accepting whichever one is the quickest to reach you. It helps you pass on a bad investment opportunity or a suboptimal term sheet. The income allows greater risk-taking elsewhere. The clinical anchor also buys patience that can help you win negotiations.

Regarding the clinical credibility point - realize that this credibility is a depreciating asset when you leave clinical practice, and these days it depreciates faster than it used to. Scientific advances, practice guidelines, workflow adjustments - all of these can outdate one’s professional practice context the farther removed you are. If you start saying “this is how it worked when I used to practice” it doesn’t have quite the same meaning. And with AI compressing time cycles of these changes, this matters more than ever.

The corollary that makes this practical (and in my case has been true from a personal perspective) is that reduced clinical work (i.e. part-time practice) is more powerful than none at all, and in some ways more powerful than full time practice. This is because a part-time physician keeps all of the credibility and buys back part of their hours. The dangerous cliff turns out to be between some and none - not full-time and part-time.

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When you find this sweet spot where you can practice medicine and have all of the benefits and credibility that accrue from this - and yet you have hours in which to do your experimentation and growth - you have the best of both worlds - instead of operating at the extremes. The number of days will look different for each person, depending on how they’ve constructed the other components of their career.

Sometimes the clinical anchor might need to go, if it’s the natural evolution of one’s career trajectory - and that’s OK. Some roles are going to require a full-time commitment that won’t leave space for clinical practice, or they might require leadership that is all-consuming from a time and focus perspective. Or, some clinical environments are too toxic - or the fit between the physician and clinical practice isn’t there - and those situations need to be modified in a more radical fashion.

Ultimately, what makes a difference is if that particular exit is intentional or if it’s something that gets defaulted into. There’s a difference between leaving a position if it gets too unbearable versus leaving because an experiment generated sufficient data and direction to drive an informed decision into a new path.

Keeping that clinical anchor as your foundation will cost you some hours in the short term and might slow the trajectory of what you’re building - but leaving and being wrong costs you the credential and context that made you really interesting to someone else in the first place.

Think about your clinical career as something that gives you a stronger place from which to grow, instead of something that’s holding you back. Re-design the foundation, and build the next layer on top of it.

Over time, the different proportions of clinical work can change, but the constant that stays is the credibility, judgement, perspective, insights, and relationships that come from actively practicing medicine.

• Scott F. Cameron, MD is a practicing radiologist, AI implementation leader, angel investor, and MRS Past President. He writes about physician career architecture at Physician Vantage Studio.

  Thanks for reading Physician Vantage Studio! Subscribe for free to stay updated with my coming work - including articles focused on physician career design and the future of the physician career, conversations with physicians creating their own unique paths while keeping medicine at the center, and more!

In Part II:

• How to take real career risk in measured steps, and why going all-or-nothing was never a consideration

• What changed in how he listens to mentors, and why he grew more comfortable trusting his own instinct over time

• What separates physician founders who get traction from those who stall, and the hundred-interview exercise he recommends before anyone builds anything

• Why he went back for an MBA after he had already founded a company and raised a fund

• How he structures a week across evening clinical shifts, due diligence, coursework, jiu-jitsu and two kids, and why it stopped feeling like work

• The workflow question nearly every non-clinical investor misses, and the financial question most physicians forget to ask

• Where AI dollars in imaging are actually moving, and why some deployed tools stop working six months in

• Why he protects a clinical anchor, and how any remote physician can keep teaching residents for a few days a year

• The advice he would give his 2010 self, and the two screenplays still waiting on his desk

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Physician Vantage Studio - Interview 02 - Dr. Jesse Courtier, Radiologist, Founder of Radiologue Ventures - Part II

Scott

When you’re evaluating a company for the fund, what questions do clinicians tend to ask that people on the finance side miss, and vice versa, what do finance people see that clinicians tend to miss? Give me your perspective, having sat on both sides of that table.

Jesse

Great question. One thing people coming from a purely finance or venture background, without time in practice, tend to miss is the workflow element. How does this integrate into a physician’s day-to-day? Does it require a complete workaround? Do I now have to open two new screens and copy-paste, or does it integrate seamlessly? It’s interesting - when you talk to purely technical people, sometimes they don’t even realize that’s a problem, or they think of it as a small detail, when it’s actually the biggest piece. Physicians are notoriously set in our ways, so you need something either so dramatically better that people say, of course I’m switching, or so seamlessly integrated that it just fits perfectly into the workflow. That’s one piece I see overlooked - how does this actually integrate into daily physician workflow.

On the flip side, there’s the actual financial impact. Sometimes we’ll see a great product that genuinely solves a problem and makes day-to-day easier, but cynically, that doesn’t necessarily resonate with the administrators holding the purse strings who have to write the check. Is this going to improve throughput? Bring in more cases? How does it actually impact the bottom line? Sometimes we think aspirationally that they’ll pay for it because it makes our day easier, but you need the finance lens too - is there a CPT code for this? Those are the pieces you might not see if you’re not looking through that lens.

Scott

That’s so interesting - as you pointed out, there’s real value in things that help diagnostically that don’t necessarily tie to something an administrator sees as ROI. I’m curious, of the investments coming to you in the AI-and-medical-imaging niche - are you seeing more attention and dollars going toward workflow adjuncts and solutions, or toward diagnostic tools? What trend are you seeing?

Jesse

It’s interesting - initially there was a lot of attention on the interpretive side, tools that help with interpretation, and a lot of investment went there. In some ways, being a little cynical, some systems adopt things just to say we’re using AI, we have the latest tools, and then it’s fire-and-forget - nobody checks whether the model is still working six months or a year after deployment. It’s in place, but it’s either not being used anymore, or the model has stopped working entirely.

I think we’re starting to see an early trend of more investment toward the underlying operational layer - things that can genuinely make a difference in workflow and the bottom line, and show measurable impact on throughput and care. People are realizing, this was cool to have, but six months later it doesn’t work, or we changed a protocol or upgraded software and it broke. So we’re looking for solutions with these deeper layers, under the surface, that actually make a bigger difference.

Scott

That definitely resonates with me as an angel investor - when you look at an opportunity, you want to ask how this fits into the long-term life cycle of a practice, a physician’s environment, the patients. Is it durable? Does it survive contact with reality, or does it fall apart? A great pilot presentation is one thing, but real-world deployment is another, and there’s a lot of intricacy in between. Really interesting to hear those trends.

I understand you’re also pursuing an MBA at the Gies College of Business at Illinois. After everything you’ve done - founding a startup, navigating FDA clearance, raising capital, founding a fund - what are you learning in business school that founding and investing didn’t teach you?

Jesse

That’s a great question, and I’ve gotten it from other people too. Part of it comes down to how I best learn things. I looked at the bigger programs - there are outstanding ones here in the Bay Area - but they’re also quite expensive, so I weighed cost against return. I wanted knowledge in things like accounting and operational management, which would be harder for me to force myself to learn through YouTube or a small course on my own. For that kind of material, I learn best when I have a grade on the line, a test to study for, assignments due.

It’s also an online format, much more affordable, but through a very well-respected university, and it lets me fit it into my day - listening to an article while my daughter’s at lacrosse practice, or during a dog walk. It’s not intrusive. And at the end of it, I’ll have a degree, which matters as I think about building a bigger fund down the line. Having formal training in accounting and operations lends a degree of credibility with large institutional investors. So I’m thinking about it long-term too - when I’m raising capital from bigger institutional players, having that MBA brings a level of credibility.

Scott

That’s a good point - it gives you the finance chops, but also that extra layer of credibility, to say, I actually know these fundamentals, with a credential to show for it, not just claiming it. Important message to communicate.

Walk me through the mechanics of a typical week for you. Between clinical work, deal sourcing, due diligence, advising portfolio companies, teaching, the MBA, and family, what does a typical week actually look like, structurally?

Jesse

I usually anchor my week around my evening clinical shifts - maybe seven to ten, or seven to midnight, depending on the school week too. I’ve got an eight-year-old and a thirteen-year-old, old enough now to be at school during the day. I might start a Monday morning with a school drop-off, and from there I’ve usually got meetings scheduled at least a week in advance. Then I start my day around whatever calls I have - a founder, a potential limited partner - and I also block time to write LinkedIn posts for the week, batching a set of ideas and scheduling them across different days.

I try to multitask where I can, pairing something like listening to MBA material with walking the dog, and I do a set of meetings for due diligence throughout the day. I try to automate as much as possible using tools like Notion and Gemini - I have a weekly digest set up through Gemini that surfaces the latest news on startups combining radiology and AI, and I actually found one of our portfolio companies that way, before they’d even spun out. I reach out and say, what are you working on, I’m interested, let’s chat.

I also manage a lot of email - I check it pathologically, very frequently. That happens throughout the day, and then I usually have dinner, spend some family time, and do a clinical shift, and that’s the day. I try to work in other things too, like jiu-jitsu, two or three times a week, so I have a balance of activity outside of just sitting in one room the whole time. That’s important given the other transition - going from a hospital, working with lots of different people, to a primarily remote setting. I like having a balance of human contact, whether over Zoom or in person, and spending time outdoors.

Some people say it sounds busy, but for me it doesn’t feel busy, because it’s something I’m genuinely interested in and excited about. It doesn’t feel like work - you’re not watching the clock thinking, when will I be done. That’s a great thing to have.

Scott

Not just passing the time. So the clinical shifts - are they all remote, and all in the evenings?

Jesse

Yes, all remote, all in the evenings, from home. I just fire up the workstation. They’re very structured about the shift times, and being part of a large group makes the flexibility much better. When I was in a group of six, as chief, if someone needed shift coverage, I’d often just take it myself. In a group of a hundred-plus radiologists, there’s a much greater degree of flexibility if you need to switch something around. And they’ve got the remote piece down well - I fire up the workstation, do my shifts, and I’m done. No pager, no coming in at 2am. That’s very nice.

Scott

Everybody loves that. Is it five days a week, or not necessarily?

Jesse

It varies. Sometimes five days, sometimes a series of shorter shifts across six days - seven to ten each evening - which breaks up the day and helps me balance things out. Overall it’s definitely manageable.

Scott

Do you ever miss the in-person experience of a typical hospital-based academic practice - seeing fellows, residents, attendings - now that you’re doing your clinical work from home? Or does the rich interaction you get from the healthcare innovation ecosystem more than compensate?

Jesse

Good question. Part of why I go down to Stanford, Lucile Packard, once a month is exactly for that - I do basically what I did at UCSF, sitting with residents and fellows, reading out cases. It’s a nice balance, and I spend a morning there about once a month. It’s nice to sit in the chair and teach a resident, share experience, show cases in an environment with advanced, high-level cases.

I do think you want some exposure to that. Someone else asked me about this too, and I told them: look at your local hospital if you’re in a remote position, because most academic places always need volunteer clinical faculty, and the requirements are usually pretty low - sometimes just four or five days out of the whole year - and you get a teaching appointment and time with residents. I definitely recommend that to other people.

Scott

Wonderful. In a typical week, does something ever have to get sacrificed - not enough room for everything?

Jesse

That’s a good question. I try to balance it out. There are times when downtime gets sacrificed - maybe I wanted to watch a TV series - and I’ll admit, sometimes I’ll just read the Wikipedia summary instead and figure I’ve got the gist of it, or decide I didn’t really want to watch it anyway. But for the most part, I try to balance physical activity, family time, work, and investing. It’s a heterogeneous day, but an interesting one for me.

Scott

Wonderful. I want to shift a bit to the impact you’re having, grounded in the reality that you’re still doing clinical work - something I believe is central to what informs us as physicians, that clinical anchor as the credibility for everything else built around it. When you think about your day-to-day and how you express yourself professionally, what would you say are your three core values, the ones represented in your work?

Jesse

One is curiosity - learning about new things, being open to the idea that my approach might not be correct, or that something’s worth diving into further. Having a curious mind. The other pieces are truthfulness and honesty, and a sense of morality - being forthright, whether I’m talking about my fund, a startup, or clinical medicine. Being transparent is really key, and morality, having a sense of when something doesn’t feel right. Those are the core pieces for me.

Scott

Interesting. In your day-to-day, alongside all your other work, how do you view clinical work as important to who you are and what you do? What does it mean to you to keep that clinical anchor?

Jesse

I still have a real passion for pediatric radiology. It’s not that I don’t enjoy radiology anymore - I still love reading cases, calling a clinician with a finding they weren’t expecting, helping guide and direct a patient’s care. That feels genuinely impactful and meaningful to me. Or catching a subtle fracture - after doing this for a number of years, I can spot a case that would be hard for someone else to identify, feel confident saying, yes, that’s definitely a fracture, here’s what needs to happen next. Helping guide the clinician in that way is really rewarding. It definitely informs my decisions as an investor and a mentor too.

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Scott

Interesting. I’d be remiss not to ask about your perspective on AI, obviously the hot topic right now, and central to your world through the fund. What excites you about AI and medicine, specifically for radiology careers or medicine more broadly, and on the flip side, what worries you about it?

Jesse

Definitely, there’s a lot of exciting opportunity for improving day-to-day workflow, and also for democratizing imaging expertise. Some of the solutions we’re seeing take the accumulated experience of a wise, thirty-year practicing radiologist, essentially hundreds of years of collective experience and data, and spread it across multiple platforms, which can even out the playing field and improve patient care. Taking away the day-to-day mundane work and letting us focus at a higher level is genuinely exciting.

My concern is what I’d call a never-skilling problem. Those of us who trained before these tools existed built our skills the hard way. How does the next generation build the same intuition when the tools are already there? How do we train them to know when an algorithm might be wrong, rather than just trusting whatever the output is? You need the basic foundation to recognize when something isn’t right and needs a second look. Without that foundation, you’re just blindly trusting the output. That’s going to matter as we think about radiology and medical education, and finding ways to blend the two. One idea I’ve talked about is simulator time - using AI in a way that builds skill rather than replaces it, where it critiques and teaches the way I would when I started in radiology, walking through how I approach a case or think through a differential. That’s where I think guardrails need to be put in place.

Scott

It’s interesting you say that - it reminds me of an idea somebody mentioned, about designing medical or resident education, or even chatbots generally, as an adjunct or a tutor helping you, rather than an all-knowing entity that just hands you the answer. I share that same concern about experiential knowledge, and what happens to people who don’t get trained the way we were, learning things the hard way.

As a side note, there’s an interesting article I read in The Atlantic, I believe by David Brooks, arguing that we may increasingly be defined by our relationship to cognitive effort - almost as if society is splitting into two groups, one looking for the easiest way to an answer and using AI to minimize effort, and another using it to strip away rote tasks while deliberately preserving their relationship to cognitive struggle and hard work. It’s an interesting way to think about it - with knowledge becoming ubiquitous, how do you decide how and when to use it, and what the judgment looks like. I share your concern about what the next generation does with all these tools at their disposal, especially given how cognitively demanding medical training has always been.

I also came across an article you wrote about pediatric radiology needing to change its flavor in the face of extinction, which is fascinating, and a strong claim from someone who built their career in academic radiology. What were you actually trying to say, and what happened when you said it publicly?

Jesse

Definitely - it was meant to be a bit provocative, honestly a little rage bait, a little trolling. Pediatric radiology has real challenges: more than half of fellowships are now going unfilled, it has the oldest average age of any specialty, the most people heading toward retirement, and the fewest coming in. What I’d noticed was a bit of an echo chamber in the field - papers get published about the joys of pediatric radiology, but published inside pediatric radiology journals, so it’s mostly patting ourselves on the back.

I equated it to sodas having different flavors - neuroradiology is the Coke, and so on down the list. If one flavor isn’t selling and we don’t want to look at why, we tend to just change the wrapper, change the can, advertise a bit more, rather than admit maybe it’s the actual product, maybe it’s the taste, maybe it’s the things we’re doing. So maybe we should look at why: are we doing more of certain modalities? Is there less research, less innovation? Are our work models static and unchanged - people working eight to five, Monday through Friday, with no remote work, no different structures being explored?

That was meant to provoke that kind of thinking, and I did get invited to give a talk after it. It’s one of those cases where you have an idea, publish it, and it leads to other opportunities. I actually tried to publish it in a couple of academic journals first, as a letter to the editor, and no one would take it. So I just published it myself, on Medium - I’m just going to get it out there.

Scott

No one would bite. That’s so interesting. I think the broader principle is that there’s something to be said for being willing to be a critic and bring a problem to light. Sometimes the people who matter most to a profession are the ones with the courage to say what needs to be said. I’m glad it turned into an opportunity to speak on it further, and hopefully it gets more people paying attention to pediatric radiology downstream. It’s interesting that you chose to raise it that way, rather than just discussing it in a committee and letting it sit.

Now I have a few questions about your vision. As an investor, you see a lot of founders come through, many of them physician founders. Where do you think most physicians get it wrong when making the transition from clinician to entrepreneur, or clinician to investor? And what do the ones who get it right do differently?

Jesse

I touched on this a bit earlier - I think we sometimes see people coming from an academic hospital try to frame their pitch the way they’d present at RSNA, or frame a research project, full of statistics and complex graphs. And there’s sometimes a resistance to feedback - a sense of, I know this is right because I’ve practiced this way, when really you’re only looking at it from one lens.

I think the people who get it right are the ones who do real diligence early - talking to lots of different people across lots of different practices. I often recommend the NSF I-Corps program to people considering this, because part of the program requires doing a hundred interviews with different stakeholders across different practice types. That exercise is incredibly valuable. It’s actually one of the things I wish I’d done more of during my own startup - spending more time talking broadly to people. When I launched the fund, I talked to 50 or 70-plus people across different radiology practices to understand their challenges, because something that’s a problem for me at UCSF might not be nearly as big a problem elsewhere, where they’ve already found a workaround.

The people who get it right have spent that early time talking to all the stakeholders, uncovering all the different facets of the problem they’re working on, so they’re not just building something to solve their own problem, they’re building something that solves a broader, more universal one.

Scott

I love that perspective - taking it outside yourself, asking what other stakeholders think about what you’re building, bouncing it off as many people as possible, and then adjusting your course based on that feedback.

When you talk about wearing new hats - clinician entrepreneur, clinician innovator, clinician investor - it can change your relationship to risk. I’m curious how your relationship with risk has evolved, given that medical training makes us fairly risk-averse by design, while entrepreneurship inherently involves risk. What would you tell a physician whose risk tolerance feels like the biggest barrier to building something?

Jesse

You can be measured in how you take risk. I didn’t start living off credit cards or put myself in that kind of position - you don’t have to. You can find a structure that lets you explore your interests without going all-or-nothing, because everyone has obligations, children, and so on. It’s possible to find something that lets you sustain yourself, or do well, while also exploring a new area.

There’s an opportunity-cost gap in radiology relative to what you might earn at a practicing radiologist salary versus, say, going to work at an investment firm - there’s a real gap there. But there are ways to blend the best of both, to create the opportunity to pursue what you want. You don’t have to go all in. You can be measured and stepwise about it.

Scott

Would you say that over time you’ve become more comfortable with risk, and you’re taking on more of it as a result?

Jesse

Yes, that’s exactly right. Earlier on, you have mentors and people telling you this is the path, and deviating from it is bad, you’ll ruin your career. Over time, I’ve become more comfortable saying, this feels right for me, I want to try this. I think it’s okay to take a step in a different direction, and I’ve generally found that the more you follow your genuine interests, the other things tend to come along with it. It doesn’t have to be a straight-line path.

I could have kept publishing - I got a pilot grant on diffusion tensor imaging in pediatric renal transplants, a good project, but very niche, and as I got further into it, I didn’t feel it would let me make as broad an impact as some of these other innovative directions. Following that instinct led to more opportunities as I published, worked, and iterated on other things.

It’s about listening to your own instinct, but also having thick skin. As an entrepreneur, there will certainly be people who say the idea isn’t good, it’s not going to work. There’s that Rudyard Kipling poem, ‘If’ - the gist of it is listening to yourself while also weighing other people’s doubts. Having a bit of both, not being a hundred percent closed off to feedback but also not letting it dictate everything, is what makes balancing the two genuinely challenging.

Scott

Very interesting, and very wise - a measured approach to risk, embracing some of it while staying aware you could be wrong and might need to adjust. If you could sit down with the Jesse who had just joined the UCSF faculty back in 2010, before any of this, and give him one piece of advice - not necessarily what to do, but how to see the next fifteen years - what would it be?

Jesse

That’s one I’ve thought about, because in some ways, the path that led me here is where I feel like I should be, so I wouldn’t necessarily say deviate. But I’d say: keep an open mind. Learn how to say no to some things and yes to others, and feel okay saying no to certain opportunities, while stepping up for opportunities you don’t feel fully ready for - because you’re never a hundred percent ready for anything. It’s easy to think, maybe in five years, maybe in ten years, I’ll apply for this. Try it now instead. Sometimes you apply for one thing and get something else that still moves you in the right direction. But you won’t get any of it unless you ask, unless you take the step.

So that’s the one piece of advice: if there’s an opportunity you want, just try it. The worst that happens is you fail, and you learn from it - failing forward. You tried, it didn’t work, but you learned something you can use to succeed next time.

Scott

Is that what you’d say to a physician who’s been carrying an idea around for years but hasn’t acted on it, wondering how to actually get started? Just take that first step and see what happens?

Jesse

Taking that first step is the biggest thing, and it’s always the hardest one. But once you take it, the next steps seem to get easier. It sounds a bit mystical, but opportunities seem to come once you start heading in that direction - you realize this isn’t as challenging as you thought, or you’re learning something, or meeting someone new who can help you along the way. Taking the first step is really the critical piece. And if it doesn’t work, you’ll learn something from it, and you’ll be better for having tried, and you can use those lessons the next time you have that same idea.

Scott

That’s wonderful. I sometimes call that first step creation - the first turn of the wheel. The beautiful thing is you don’t need anyone’s permission or prescription to do it. Often it’s accessible to you right from where you are now. Identify that first step, take it, and the next one shows itself to you - but you have to give yourself permission and believe you can take that step and see what happens, to get the wheel turning.

Last question. The career you’ve built so far is extraordinary, and it clearly isn’t finished - it’s still ongoing. What are you still curious about that you haven’t followed yet? What’s the door you’re standing in front of?

Jesse

Definitely - my goals are to keep building the fund, to build out the next generation of it as we grow, and to expand the types of companies we’re investing in. That’s one area for sure. I also want to keep improving my impact on the field as a whole, through mentorship, investment, and clinical practice - all pieces that really excite me.

And then, in the back of my head, I’ve got two screenplays. I’ve put one down on paper; the other is still mostly in my head. At some point I’ll get those out there - they’re science-fiction-leaning, conspiracy-theory stories that actually have a radiologist at the center of them. There’s no shortage of ideas for me. It’s really about finding the time and deciding where to focus it.

Scott

I love it. Wonderful - I love that there are these other interesting side projects you’ve been noodling on. Keep that creative side of your brain engaged. Is there anything else, Jesse, that we haven’t touched on today that you wanted to mention?

Jesse

No, no - again, I’m excited about this series and grateful for the opportunity to speak today and share some of the insights from my career. I always appreciate the opportunity.

Scott

Wonderful. Jesse, I think one thing I’ve learned from you is that the career you’ve built isn’t the result of one lucky break or one interesting moment - it’s the accumulation of someone who decided, I’m not just going to take the default path, as good as it might be. I’m going to lean into my interests and desires and layer complementary things on top, to expand my impact as a physician and live a fuller life, and, as you said at the outset, contribute in a bigger way. Kudos to you for setting that example and showing all of us that you can say yes to these adjacent opportunities and still make a real impact in clinical care. Thank you for demonstrating that.

Jesse

Thanks again, Scott, for the opportunity. I think it’s a wonderful platform you’re building, and I’m really excited to have participated.

Scott

Thanks so much, Jesse. I hope other physicians can learn from your example and follow in some of your footsteps. For those who want to get in touch with you, where’s the best way to find you and your work?

Jesse

Probably LinkedIn - that’s where I’m most active, and you’ll see the latest of what I’m working on and building. Feel free to follow or connect.

Scott

Wonderful. And for those of you following along with my work, you can access my essays, frameworks, and videos at https://physicianvantage.com. Thank you so much, Jesse - it’s been a pleasure, and I look forward to talking with you again soon.

Jesse

Thanks so much, Scott, I really appreciate it.

• Scott F. Cameron, MD is a practicing radiologist, AI implementation leader, angel investor, and MRS Past President. He writes about physician career architecture at Physician Vantage Studio.

  Thanks for reading Physician Vantage Studio! Subscribe for free to stay updated with my coming work, including more conversations like these centered around physician career design.

In Part I of our conversation, we discussed the following facets of his very interesting career:

• Why he still introduces himself as a pediatric radiologist first, and how that identity drives every other decision he makes

• The gap he noticed during a surgical internship in Hawaii that became a company fifteen years later

• How he taught himself to code from YouTube videos, built his first prototype on a HoloLens he bought himself, and carried it through to FDA 510(k) clearance

• The one-line answer he found on Google that told him it was time to make his move

• The specific schedule and practice redesign that handed him back his entire daytime without giving up clinical work

• Why he started his own fund rather than joining an existing one, and what Radiologue Ventures actually looks for

• Why he believes physicians badly underestimate how far their skills travel outside the specialty

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Physician Vantage Studio - Interview 02 - Dr. Jesse Courtier, Radiologist, Founder of Radiologue Ventures - Part I

Scott

Hi Jesse, it’s great to have you here today.

Jesse

Thanks so much, Scott, for the invitation. I appreciate it.

Scott

Thank you so much. I’m going to try to introduce Jesse in the best way I can, but when I tried to come up with something concise, I kept running out of categories. Jesse Courtier is a physician - a radiologist, entrepreneur, and investor. Some of the categories you might use are pediatric radiologist, professor, section chief, startup founder, FDA-clearance navigator, augmented reality pioneer, venture capitalist, Stanford adjunct faculty, and MBA student. That’s not a career, that’s a portfolio. And the interesting thing is that it doesn’t read as scattered - it reads as intentional. That’s what I’d love to explore with you today, Jesse.

So first, how would you introduce yourself at a dinner party - not a medical conference, but a dinner party where people don’t know your background?

Jesse

That’s a great question, and it evolves a bit. More recently I’ll start off by saying I wear a lot of hats - I do several different things - but I primarily think of myself as a physician, a radiologist, a pediatric radiologist. That’s where my passion is, and that’s where everything else comes from. That identity informs my decisions and is really the inspiration behind becoming managing director and founder of Radiologue Ventures, founder of a startup, and a graduate student. Those are all different things, but being a radiologist and a pediatric radiologist is my guiding principle - it’s what inspired me to take on these other challenges. So I often say, yes, I wear a lot of hats, but I’m a physician and a radiologist first.

Scott

Wonderful. So you frame it as physician first, radiologist second, and everything else layered on top. Is that right?

Jesse

Exactly. The thing I’m most focused on right now is building my fund, and what excites me about it is that it sits at the intersection of radiology and AI - that combination gives me a different track alongside my normal physician career. It’s an area where I can use my clinical experience to help inform decisions and push the edge on innovation.

Scott

Wonderful. Tell us a bit more about your background and where your journey started. What led you to medicine in the first place, and then to radiology specifically? It strikes me that radiology is an interesting choice for someone who turns out to be deeply interested in collaboration, communication, and building things with other people.

Jesse

Definitely - I’ve always been interested in the sciences, even early on. I started at USC thinking I’d do biomedical engineering. That combination of the technical piece with the human element appealed to me, but as I got into it, the engineering side didn’t quite resonate. So I did a summer doing basic research with a physician at the University of Florida, and through talking with him, I realized medicine was probably the better blend of what interested me - the human side and the technology side.

So I went pre-med, and I actually majored in anthropology. I’d done a related project in high school and found it fascinating, so I wanted to dig deeper. I still completed my pre-med requirements, but rather than the standard biology major, I wanted to study something I was genuinely interested in. It was fascinating - learning about different cultures and languages really helped me focus and do my best in my studies, and get the grades I needed for medical school.

The other piece was my work-study job in college, which was in IT - I worked tech support. I learned a ton about troubleshooting different technologies, back during the early iterations of the internet. It taught you how to approach a problem even when you didn’t know the specific software. I sometimes joke that I learned more from that job than from many of my college classes, just from the practicality of the experience.

In medical school, they introduced radiology very early in the curriculum, and the radiologists there fascinated me - it felt like they had a superpower. They could see things other people couldn’t, and they’d be right. So I got interested in radiology very early on, because it felt like the best blend of technology, humanity, and medicine. I also found that radiologists are really the doctor’s doctor - that’s where the collaboration piece comes in. Everyone else on the team may have their own piece of the puzzle, and sometimes we’re the ones who put it all together and land on the diagnosis. That really drew me to the field.

I did my fellowship training first in body imaging, then in pediatric radiology, which I was also interested in. They were opening a new children’s hospital at the time, and said if I did the training, I could stay on faculty. So I did the training, really enjoyed it, loved the pediatric element, and stayed on faculty there for about fifteen years.

Scott

And this was at UCSF, correct?

Jesse

Yep, that’s right - UCSF.

Scott

That’s wonderful. I love that narrative arc - starting in biomedical engineering, which I also did as an undergrad, and then, like you, switching to a non-technical major. For me it was about having more latitude to take other courses I was interested in while still fulfilling my pre-med requirements. And I love how you circled back to IT and picked up that technical piece as well.

It feels like that analytical, problem-solving part of your brain has been running the whole time, and it eventually led you into residency and radiology. Thank you for sharing that background, and for making the point that radiologists collaborate closely with the whole care team and often bring the diagnosis to life.

Let’s touch on the anthropology piece at USC a bit more. It’s an unusual foundation for someone who ends up this deep into technology, not just on the practice side but on the investment side, building a fund of tech-enabled companies. What did studying how cultures organize themselves give you, in terms of how you see problems, read a room, and evaluate people?

Jesse

That’s a great question. I think it shapes how I approach conversations with investors or startups from different cultures - how do they think about things, how do I approach that? Sometimes I have to take a step back and ask, am I being too direct, or too indirect? Some cultures don’t say exactly what’s on their mind, and others do. Learning to read what’s appropriate to say, and managing that as I talk to different startups and investors, has really helped me.

I find anthropology fascinating more broadly too - both historical and current cultures, how they manage family, think about relationships, think about work, and how they put it all together. I also enjoy learning languages. My wife is Thai, so I learned to speak Thai to better communicate with my in-laws. That human element fascinates me, and it’s relevant to patients too. As a physician, caring for people of all different cultures - and San Francisco in particular has a very multicultural patient population - being able to relate to them and understand contextually why a family might want to be in the room, or might not, has been really helpful for me as a physician.

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Scott

Wonderful - so there’s a personal layer to it, and it informs how you navigate the dynamics of people, which is so important in practicing medicine. Fascinating.

I also read that you did a surgical internship before your radiology residency. Tell me how spending time on the surgical side changed how you see what radiologists do, and don’t do, for their surgical colleagues. I think that internship was also where Sira Medical was born, years before you knew it. Talk to me about that.

Jesse

Exactly, and I really enjoyed it. It was at the University of Hawaii, a busy year, and one that was very resident-and-intern-driven, so I wasn’t just on the floor doing dressing changes. I was in the OR doing appendectomies and inguinal hernia cases - sewing the skin was always my favorite part.

But from the standpoint of what really stuck with me: I saw the pain points in translating radiology’s 2D information into the model the surgeon actually needs in their head when they’re operating on the physical patient, with retractors in hand - a very different context than radiology. There was a real gap between the information that’s useful and actually applying it to the real patient. I did an orthopedic month in particular, working with complex fractures, which are essentially a 3D jigsaw puzzle - how do you put it back together? Spending time with a radiologist was helpful, and I eventually started learning how to build those models in my own head. Finding better ways to translate that information was one of the gaps I clearly saw as a surgical intern.

Scott

Very interesting. Tell me a bit more, briefly, about Sira Medical. What did it do, and why did it come about?

Jesse

Certainly. It grew out of time in the reading room, finding myself on the phone with a surgeon, or writing in my report, trying to paint a picture of a very complex post-surgical case or fracture, in words. Sometimes I’d end up drawing a doodle, and that would help. But I felt there was still a gap. I looked into 3D printing originally, but there were time and resource constraints at the time, and then I heard about augmented reality and thought, this might actually be an interesting way to close that gap.

I learned to code off YouTube - we didn’t have any formal training in it - bought my first HoloLens, and built our first prototype. From there we got just enough proof of concept to get funding through a catalyst program, which let us get more funding to build it out further. We brought on our catalyst-program mentor as CEO when we decided to spin the company out, and just iterated step by step, getting more funding, more evidence, and building on each piece until we got FDA 510(k) clearance.

You learn a lot along the way - what to do, what not to do - from pitching to investors, finding out what resonates with them, building the kind of evidence a hospital needs to actually purchase your product. None of that is taught in medical school. I did take the Startup 101 course that UCSF offers, which gave me a helpful foundation. That course was super helpful, because a lot of times you think about presenting your work the way you’d present a scientific paper, but investors want to see problem, solution, competition - all these pieces laid out differently. It was learning through a completely different lens. A great process.

Scott

A different lens, very interesting. I love how you started with a problem you detected in your day-to-day practice in the reading room, decided this isn’t being addressed well, and then built a prototype yourself, ran with it, and eventually raised capital and went through the FDA clearance process. What I also find impactful is that you combined two things - teaching yourself through YouTube tutorials on the HoloLens and coding, while also leaning on the established startup curriculum available to you. I love that strategy of blending those two approaches.

Jesse

Exactly - you don’t have to do all of it yourself. Get it to a certain point where other people can see the vision, and then bring on people with the extra technical or business expertise you need, and build a team. That’s another important piece.

Scott

Wonderful, both of those elements are so important. Now, fast forward a bit - eventually at UCSF you became chief of the pediatric radiology division. By any conventional measure, you’d arrived: successful, well respected in the department. The natural next step might have been department chair, or chief of a larger unit. Walk me through what was going through your mind at that point - not the polished version, but what it actually felt like to look at that path and ask yourself whether it was what you wanted to continue down.

Jesse

Exactly, that’s a great question. At the time, there’s the traditional pathway - chief, to chief of a bigger place, to chair somewhere - and I explored those options, looked into different chair positions and chief-of-larger-unit roles. I felt like, sure, that’s one path, but would I actually be happy doing it?

There was another thread I’d always had in the back of my mind. I’d always loved innovation - I’d worked with our innovation ventures program doing mentorship, and with the Plug and Play tech center mentoring startups. Originally I thought, maybe that’s ten years down the road, maybe I’ll do some angel investing, build up a track record, and maybe someday get into it more seriously. But the more I thought about it, that felt like more of a pull. It wasn’t that I was being pushed away from something I didn’t like - it was a genuine pull toward stepping away and focusing on the fund.

There was another piece too - when I was building the startup, I had one foot in two worlds, trying to do both at close to a fifty-fifty split. This time, if I was going to start a fund, I decided to step away from the other piece entirely so I could focus and get this one off the ground. I felt like I could have the most impact, and the best chance of growing this idea, if I stepped fully away and focused on it.

There were definitely people who, without saying it directly, implied I was throwing away my career - ‘are you having a midlife crisis?’ I wasn’t out buying a motorcycle, but for me it was more this genuine draw toward doing it. I got into VC Lab, an accelerator for venture capital funds, which was an amazing program. It meant I didn’t have to spend ten years working through each step of building a fund the traditional way - I already had the expertise, the network, and a thesis. And really, the key piece is that if you can believe in yourself, other people can believe in it too. You have to believe you can do it first, and once you do, people say, yeah, I want to get on board, I want to grow this with you.

That was what let me feel like I was on the right track. I didn’t feel any regret about stepping away - I enjoyed that chapter, but I felt like it was a chapter, and this was the next one. At least, that’s how it felt for me.

Scott

Wow, that’s so impactful - there’s a lot to unpack there. What I really admire is that, despite being very successful with a great leadership role at a wonderful institution, you said, I feel something pulling me. That’s a very different sensation than someone who’s not thrilled with what they’re doing and doesn’t know what’s next, just dabbling out of fatigue or burnout. What you’re describing is more like an intellectual itch you’d been trying to scratch for a while, and deciding to go down that path.

I also love how you leaned on an existing accelerator program rather than reinventing the wheel - finding people with real expertise in what you wanted to do and getting up to speed through them. But I think the most important thing you said was about believing in yourself - you have to bet on yourself and believe you can do it before anyone else comes on board. Would you agree that’s the biggest piece of all of it?

Jesse

Definitely. You have to believe in yourself, tell yourself, I’ve got the tools, I can do this. Once you have that belief, and once you show it, you can take something that’s just an idea in your head and start turning it into reality. I think that’s really fun.

Scott

That’s wonderful. Just realizing it’s something you can do - that you have the choice. You don’t have to stay on the predefined ladder, climbing to the next rung the way most people do. You have the choice to step off, or pause, and explore something else. That’s all agency you have.

Jesse

I’d also say that opportunities come once you’ve made that leap, ones you wouldn’t expect. For instance, I get more national speaking invitations doing this now than I did when I was chief at UCSF last year. People said I was throwing away opportunities, but I actually get more talks now - at RSNA, SPR, places like that - than I would have otherwise. I think when you’re genuinely pursuing your passion, other people notice and want to learn more. These opportunities find you once you start heading down something you’re passionate about.

Scott

Wonderful. Following this thread - at some point, as an evolution of the thinking you just described, you decided it was time to step away from your leadership position at UCSF and transition to Bay Imaging Consultants, where you still practice radiology, and around the same time Radiologue Ventures was born and taking shape. Walk me through the how and why of that specific transition - changing practices and launching Radiologue. What did you have to give up, what did you gain, and how did you know the timing was right?

Jesse

For me it felt like there’s a point in a career where you feel like you’re near the ceiling of what your current role allows. One of the things I found when I was Googling ‘when is it time to switch jobs or find a new career’ was an answer that said: it’s when you start Googling that question. I thought, okay, that’s actually a good indicator.

Scott

I love that - it’s exactly what you were doing.

Jesse

Exactly. One of the nice things about UCSF is a broad network of former trainees and residents, and one of the leaders at Bay Imaging Consultants has daughters who go to the same school as mine. We got talking, and it turned out they were looking to fill evening shifts - the kind of shifts people don’t necessarily want, so they compensate a bit better for them. That worked well for me, because it let me balance my time so I could focus on clinical work in the evening, without long call shifts or carrying a pager the way I did before, and step back from the administrative roles to really focus on this critical piece, freeing up my daytime for innovation work.

It’s worked out well - a great group. It also gave me a new perspective on private practice. Coming from an academic world, everyone’s on one system, using the same templates. In a private group, you’re covering multiple different hospitals and systems, and figuring out how to navigate that. They do a great job of it, and it gave me a new appreciation for how the private world operates. So overall it’s benefited me, I think.

Scott

Very interesting. I like how you found a way to structure things so you could do everything you wanted. A lot of physicians struggle with the question of when the timing is right - there’s always a reason to wait, a committee obligation, a training cohort, a department that needs you. It sounds like the timing became right because you felt the pull, and you found a way to mechanically construct your schedule so clinical work and the investment side didn’t compete for the same hours.

Jesse

That’s exactly right. There’s an old quote - people wait for the perfect time to start, but the starting is the perfect time. That’s really the thing. You just get it done.

Scott

Wonderful. Let’s jump into Radiologue Ventures. Tell us what Radiologue Ventures is, why you started it specifically rather than joining an existing fund, and where it stands today. Give us a real picture of what you’re building.

Jesse

Definitely. We’re focused on investing at the intersection of radiology and AI - pre-seed-stage companies tackling workflow bottlenecks in radiology, across the whole imaging lifecycle, from scheduling, authorization, and planning on the front end, through interpretation, protocoling, and performance, to communication on the back end. Those are the areas where we see the real challenges in radiology imaging, alongside the constant challenge of physician burnout. Our goal is to use technology to genuinely improve imaging workflow.

For me, this felt like a challenge I’m uniquely positioned to help solve. As radiologists, we’re so often passive consumers of technology - we don’t have much input at the very start of the process, and we end up with software that either doesn’t solve a real problem and adds time to the workflow, or just doesn’t do what it’s supposed to. I made it a goal to identify companies actually solving real problems, and to use my own experience taking something from zero to FDA 510(k) clearance and funding to help founders who have a spark - a little ember - and help guide them into a bigger flame. That’s what I decided was the best fit for me, after talking to a lot of people and refining the thesis and the stage I should focus on. That’s why I felt I could make a real impact here, rather than starting as an analyst and working my way up through a fund the traditional way. We’ve now built up the fund, completed our first close, and just finished our fourth investment. It’s been really exciting - I’ve gotten to meet a lot of different startups, see the cutting edge of the technology, and find founders doing genuinely impactful work that I can help support. It’s been a lot of fun.

Scott

That’s great, congratulations on all the progress with the fund. It sounds like an amazing niche, and as you pointed out, it’s very well suited to your background, skills, and interests - almost as if it was built for you, given where you’ve been and where you want to go. That’s a great match between founder and company.

Related question: do you think physicians should operate in their zone of genius, their zone of passion, or somewhere at the intersection of the two? How did you navigate that for yourself?

Jesse

That’s a great question. I think it ends up being a mix of both - where you have talent and experience you can leverage in service of areas that genuinely interest you. It can get challenging if the two things are too disparate - if I decided tomorrow I was going to become a four-star Michelin chef, I have zero experience in that. But if you have real expertise, the question becomes, how can I leverage it in a way I might not have initially imagined - whether that’s investing, entrepreneurship, or advising and mentoring startups.

I think we have a lot of practical experience and translatable skills. Someone else asked me about this too - the diligence, the focus, the technical dedication that got us through medical school, and then, as a radiologist, how to navigate working, collaborating, and building things with others. Those skills translate to a lot of other endeavors. I think physicians sometimes underestimate ourselves, thinking, this is just my niche, but there are a lot of skills we have that apply well beyond it.

Coming up next week in Part II… we'll learn from Jesse about the weekly automation that found one of his portfolio companies before it had even spun out, the hundred interviews he thinks every physician should do before building anything, why some AI tools stop working six months after they're deployed, and Jesse's warning about what AI could cost the next generation of physicians - and a hint - it isn't their jobs.

• Scott F. Cameron, MD is a practicing radiologist, AI implementation leader, angel investor, and MRS Past President. He writes about physician career architecture at Physician Vantage Studio.

  Thanks for reading Physician Vantage Studio! Subscribe for free to stay up to date with my coming work, including receiving part II of my conversation with Jesse.

Walking with friends and family along the rocks in Gloucester, MA

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I had the good fortune of traveling with my family recently, in the embers of the remaining days of summer, to Gloucester MA. We stayed with friends at their summer home, an airy, expansive retreat set up high on a grassy and rocky bluff overlooking the coast, where boats dotted the water. On the first day there we all sat together on the couches in the living room, snacking and lounging while the kids played outside, and as I surveyed the room while we were still settling in, my eyes drifted to the books resting on the coffee table in front of us. One book on the bottom of the shelf caught my eye - All the King’s Men, by Robert Penn Warren. As I picked it up and ran my fingers along the sheen of it’s cover, I smiled as I recalled reading this same book, many years ago, when I was in high school.

The interesting thing is that I don’t remember much of the content of the book at all. But what I do vividly remember is how much I loved reading those novels and dissecting them in conversation with my classmates and teachers, all of us arranged around an oval table. The curiosity, the learning, and not knowing what was around the bend on the next page - all of these held my fascination back then, and they do today. It also made me think of my love for reading overall - how I enjoyed (pre-kids) reading the WSJ weekend edition on Saturday mornings with a cup of coffee - and how my love for reading is in many ways a proxy for my curiosity.

A lot of physicians are curious by nature, and even thinking back to medical school interviews, there are many questions that specifically aim to learn how broad, curious, and well-rounded a potential doctor candidate is: ‘tell me about the most interesting book you’ve read recently’, ‘tell me about your semester abroad’, ‘what was the biggest challenge you’ve faced and how did you come up with a solution for it’, and so on.

But as time goes on, these facets of our personalities and lives start to get crowded out with the demands of medicine and of life. So there’s a paradox - medicine attracts some of the most curious people around, but then - over time - methodically narrows them. It’s a gradual shift, and in many ways one that’s necessary, but it results in changing the way we think and operate - but as I’ll explore here, there is a way to re-introduce that curiosity and that range into our professional portfolio.

Narrowing isn’t necessarily wrong, and actually in a lot of ways, it’s exactly what medical training is supposed to accomplish - taking someone who’s broad and teaching them to focus intensely on a given set of subjects to develop real expertise. The problem comes when we assume that a necessary period of narrowing has to propagate into the rest of our careers.

From the outset, medicine doesn’t actually select for narrowness - it actually rewards those who are more than just academic stars - committees love uniqueness as well as well-roundedness, and if you have something really novel - let’s say a ‘Program II’ major, offered at some undergraduate institutions, where you can create your own hybrid bespoke major, you have the potential to really stand out. If you’ve done research in an unrelated field - all the better. If you’ve spent a year volunteering somewhere, building a program, championing a cause - all of this speaks to individual breadth and helps get your foot in the door. These versatile, creative, and bright people tee themselves up well for admission to medical school.

Going through medical school, though, a shift happens - the intensity and dense curriculum and rotations become all consuming, and require almost all attention and focus that’s available (above and beyond core relationships, existential needs, etc). And so those activities that were part of who you are start to get crowded out one by one - maybe there’s no time to practice the piano, or work on that screenplay. The pick up basketball games might need to go. And at the same time, the way we’re evaluated in pre-clinical and clinical years depends on our depth - how well do you know the material and the skills? Also, there tends to be a consensus from mentors and teachers to stay focused on one’s coursework in order to get the high marks, learn the core curriculum, and set oneself up for the next step in the journey - those other aspirations, such as writing, innovation, etc can come later on. Ultimately, it’s not a single choice that narrows the personal and professional life - it’s the sum total of many decisions, all of which make sense in the moment - and realizing that your peers are making the same ones.

There’s a price we pay for all of this.

One of the biggest ones is the ability to not have guilt about being interested in something for it’s own sake - purely for curiosity or joy - instead of for a utilitarian reason. This human side of us - the creative, the curious, the spontaneous - gets suppressed to a degree. We might lose touch with the experience of being a beginner at something - and with this, paradoxically, losing some of the fun and satisfaction that comes from the growth and discomfort of being on that slope of the learning curve. Sometimes you even lose touch with part of your social circle that was part of that life - the running club mates you don’t see again, the improv and theater partners that you no longer banter with. Again, these are innocent casualties of a path that is shaping you to be the expert that you need to be.

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But that curious part of you, the part that is expansive - is still there, and you can see glimmers of it time to time, like when I lifted up that Robert Penn Warren book in my hands and felt its weight, and knew - if I wanted to - that I could escape for a bit to read a few passages. You see it when you stack certain podcast episodes back to back and listen all the way through, when you collaborate on an opinion paper with peers from different institutions and you go deep - or even the food festival you went to this summer that you can’t stop talking about.

To reawaken this, think about what it was in your life that started to narrow down first - for example, that thing that you used to do, simply because you enjoyed it? If you have it, think about how to re-introduce a component of this at a small scale into your life. For me, it could be carving out 15 minutes at the end of every evening to read a short chapter in a fiction book. For others it could be sitting 10 minutes at the piano, with a YouTube tutorial on your tablet which is propped up on the stand. You’re essentially re-introducing this thing at the beginner level, and acknowledging that it doesn’t necessarily have to have a purpose with your current project or career.

The broad and curious person who became the doctor is still you - it’s just that medicine required narrowing certain parts - and you have to be the one to reintroduce the re-expansion. Then, your natural arc as you progress on your medical journey becomes something like this:

Explore many things → Narrow as medical training demands focus → Master the domain with clinical judgement and expertise → Expand as your accumulated assets provide you with new possibilities.

This four-part arc is helpful because each component has a purpose. In the Explore phase, breadth helps you discover who you are and what your innate curiosity leads you to. Narrowing allows concentration that results in real expertise. Mastery provides clinical judgment, relationships, credibility, and personal/professional capital. Ultimately, at some point down the line, those accumulated assets provide you with a way to expand once more - this time from a stronger foundation.

So expansion in mid-career becomes a byproduct of everything you spent the first half of your career building. It’s what all of that expertise now makes possible.

Walking along the seaside path in Gloucester, MA

As physicians we spend the first half of our career deliberately narrowing to build expertise. The opportunity in mid-career is to use that expertise as the springboard for expansion - wherever that curiosity and interest may take us. Perhaps it’s learning about AI, perhaps investing, teaching, podcasting, or leading an innovation project. Whatever it is, it’s re-discovering that part of ourselves that has been dormant - but that has been there all along.

This is also where curiosity can become an intentional part of career architecture. Once we hit mid-career, medicine has given us assets that we didn’t have when we started out, such as expertise, credibility, judgment, relationships, along with some degree of financial stability. We can take these assets and let curiosity guide us towards how to use them - all while keeping our clinical foundation intact.

So that curious young doctor who first put on that white coat years ago is still there - but the experience earned over the years have now given this person more skills, resources, and directions to explore.

What’s an activity you were curious about before medicine started the narrowing process? I’m curious; let me know in the comments.

• Scott F. Cameron, MD is a practicing radiologist, AI implementation leader, angel investor, and MRS Past President. He writes about physician career architecture at Physician Vantage Studio.

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We also discuss what it’s like now for him to work roughly 25 clinical hours per week, and Bart's argument for what the real thing holding physicians back is - and a hint - it’s not time or money.

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Physician Vantage Studio - Interview 02 - Dr. Bart Kaczmarek, Family Physician, Founder of DoctorFlow - Part II

Scott

So now, you created all of this while seeing patients full time and teaching residents. How did you protect the time to build CRAFT [see part I of the interview] and DoctorFlow? Where did you find the time to develop all of this?

Bart

It came out of necessity. What’s my next step, what’s the lowest-hanging thing I need to fix to be more efficient? If one nurse helps me but I don’t have enough of her time, I need to hire another one. Then, how do I manage two or three nurses without them bumping into each other? That’s what created the need for a tool that tells my prepping team where to go first, and leaves a sign for me - where do I go next, and for what? Is it a diabetes follow-up? A joint injection follow-up? A cosmetic procedure? So I walk in already knowing who’s next and what kind of encounter is waiting behind the door, just by looking at DoctorFlow. It became a tool almost as a natural next step.

DoctorFlow is essentially room flags, reimagined for 2026, with separate views for the prepping team and the doctor, handoff messaging, and a lot of automated functions. And the most beautiful part at the end is the KPIs - I know exactly how much time I spent in the room versus not in the room, which tells me lost opportunity for income. That’s what I track, to see which parts of the day I can fill with more patients. I’m never idle. I’m always moving room to room, using my time at the highest possible capacity.

Scott

So tell me a little more about DoctorFlow itself. You described it as the 2026 version of flagging the room, giving you information, data, and metrics. Tell me what it is at a high level, and how it works.

Bart

It’s a hardware system - tablets mounted on every patient room door, and a set of TVs in high-traffic areas. Some of our clinics have one screen, some have two, three, or more. There’s software running on them that separates a queue for the prepping team and a queue for the doctors, and it enables handoffs. Say my patients are all prepped when I walk in, but then someone mentions, ‘can you also give me a TDAP vaccine?’ I say, of course, and my nurse will be right in - I leave the room, press a button, and she’s flagged to come back in for the vaccination while I move on to the next room. I’m not looking for anybody.

Those handoffs are incredibly useful. I used to yell down the hallway looking for my nurse, or ask my secretary, ‘where’s my nurse?’ while she was on the phone saying, ‘wait, wait, I’m on a call.’ Now none of that happens - the system tells me which room is prepped and ready for me next, and I just keep moving. My longest gap between patients is the walk from room one to room seven, maybe fifteen steps. That’s my longest break. A perfect day for me is zero breaks all morning and completely continuous patients all afternoon - a hundred percent utilized day.

Scott

I love it. So how long did it take from the idea - let me create something like DoctorFlow - to formally systematizing what you were doing? How long from first thinking of it to having it fully built and ready to implement, both in your own practice and in other practices?

Bart

That’s actually a deep question, with a lot of context. I realized we were moving to a larger practice, and paper flags on the door wouldn’t work anymore for seven or nine rooms - we’d all be confused. So I hired an IT contractor off Fiverr, and he built an app for me for $250. That was it. I started using it, and it was great.

Then someone saw me using it and asked, what is this? I explained what I used it for, and they said, why don’t you sell it? I said, sell it? This is just me, I’m this weird guy, nobody works the way I do. But it started growing on me, and eventually I thought, let’s go for it.

The gap between building something for yourself and preparing it for the market is the main problem. There was so much I didn’t know, and had to learn - I’m still learning. I can teach other doctors about efficiency, but I’m a student when it comes to running a business, sales, marketing - an enormous amount of knowledge I didn’t even know existed. But I’m grateful, because I’m having fun learning it, discovering what I’m doing wrong all the time, and correcting it. That’s been fabulous.

Scott

Would you say there wasn’t much delay between having the idea and tinkering with it, versus deciding to formalize it and bring it to other practices? Was that a quick ramp-up, both in terms of time and psychologically? Or did you sit with it for a while, thinking maybe I should just keep this in my own practice, before eventually deciding to make it something more formal?

Bart

It took me a little while, because I didn’t quite accept that it was possible - I didn’t see myself as someone who could build this for other people. At the time I was also involved in organizing medical buildings under the name Hope Health, as an equity partner in a new building, and I was already organizing work for other doctors using my system, so I was busy with that. Once I got moving, the execution itself wasn’t very long.

What I notice about myself is that the biggest result of all this learning isn’t the money. The biggest result is that the loop between having a concept and executing it keeps getting shorter and shorter. If I have a thought and decide to act on it, it’s not two weeks anymore, it’s not even a week. The shorter that loop gets, the more I know I’m actually learning. That’s the real payoff.

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Scott

I like that. So when you approached other practices with DoctorFlow fully built out, and offered to put it into their practice, how did that go? What was harder than expected when you were trying to sell it to other practices and get it installed? Tell us about that part.

Bart

I realized I had a lot to learn, so I got myself a few books and started learning how to actually make offers and sell things. One of the first humbling lessons was that I had to make calls. I called everyone I knew from my contact list - made the list, printed it, called each person two, three, four times until I got through. Then I started making cold calls, which is extremely humbling if you’ve never done it. You become that same guy who calls you about duct cleaning. That’s how I reached my first customers.

Then we installed it, and I had to develop standard operating procedures for installation - it involves electrical work, hardware implementation, TV setup, staff training. We ran before-and-after surveys so we’d have a clear picture of the impact. Everything about it was new, but that was the journey.

Scott

So interesting. Now tell me how you made time for that within your typical week. Because as I’m hearing you talk, you have a busy day already, being maximally efficient, but you’re also building this new business to bring to other practices. Were you working on that in the evenings, the weekends? How did the architecture of your week actually come together?

Bart

I got used to getting up really early over the last five years - up at four o’clock every morning. I’d do an hour at the gym, and then I always had a bit of time for myself before everyone else in my time zone woke up. I leaned on that a lot, that discipline of staying on course.

The difficult part is that it’s never enough. What I’m learning at this stage is to stop always adding, because I’m fighting against my training as a physician. We’re trained in residency and throughout our careers to keep adding - scut work in residency is ‘go do five things,’ and the next night it’s ten things, and you just have to say yes and get it done no matter what. We’re trained to do that.

Scott

Yeah, exactly.

Bart

You mentioned earlier how CEOs are very focused on doing just two or three things - they’re trained to cut, to remove, to subtract from the plate. A big part of what I’m working on now is learning that skill. I’m still learning it. I’ve started removing things that no longer fit my focus. Recently, with a heavy heart, I stepped back from teaching medical students and residents - I loved it, but I realized I had to be more focused, so that cut had to happen. I also removed myself as a partner from the building I mentioned earlier, something worth probably a few hundred thousand dollars on paper. I just executed my plan of removing at any cost, and gave up my stake for one dollar, just to free up my mind for things I felt were a better investment of my time and focus. That’s a deliberate practice for me - removing. But it’s never enough.

Scott

That’s a great point. You have to be really judicious about where you’re getting the time from, and what you’re willing to let go of, if you want to layer on something new - because most physicians already have a full schedule, and it’s hard to add anything more. So let’s say a physician has a new idea they want to pursue, but a full clinic schedule. What would your advice be for their next 90 days? What should they do?

Bart

The idea would be to start with things that are highest value for zero investment - that’s the C in CRAFT. Physicians typically undercharge. I’m speaking from the family medicine perspective, but outpatient doctors in other specialties could apply this differently. In Canada, family doctors are allowed to charge private fees within certain brackets, and almost nobody charges at the high end of that range. Most doctors sit on the lower end of the allowable fees.

One of the first things I’d suggest, to free up capital to hire help and not come home exhausted, is to start charging your existing fees at the higher end of the bracket. That’s what I did - some services went from $20 to $100. It sounds drastic, but from my own experience, nobody questions it. You just do it, and nobody leaves your practice. If someone genuinely can’t afford it, I have room to waive the fee - I’m not charging everyone ruthlessly. A good example: I implemented a block fee for extra services, things like notes and paperwork, around $250 to $300 a year per patient. Out of a 4,000-patient practice, maybe three or four people ever asked me to waive it, and I agreed. It’s not hundreds of people - most people are able to pay. There are other steps too, but I’d start with the lowest-value, zero-investment moves - just adjusting a number or reorganizing your work. That’s the C in CRAFT.

Scott

So that’s a way to get some of your time back, or generate more income and trade that back for time. And once you have that, if you have another idea you want to pursue or a business you want to build, you now have more bandwidth, more time, or more capital from your existing practice to put toward that new venture.

Bart

Right, you can hire someone to help with the things you don’t want to do, which is what’s hurting so many doctors right now - they have so many things on their plate they wish they didn’t have to do. That’s the easiest way to remove it for good, and it’s self-funded. Everybody wins, including the people you hire, who now have a job. Everybody’s happy.

Scott

That’s right. Do you think it’s accurate to say what stops most physicians from starting is time or money, or is it permission, or something else?

Bart

I think it’s permission, and the mindset of thinking about an outpatient practice from a different perspective, rather than the one we know from training - what are my colleagues doing? Instead, think from first principles: does this need to be me? Do I have to do this? And if I don’t, can someone else do it for me, and how do I pay for it? Try hiring someone for it. If they say they’re not comfortable with a task yet, that’s fine - how do we train residents? See one, do one, teach one. It’s the same idea. If you’re a partner to that person and they’re eager to learn, you can teach your staff a great deal, and that’s how it’s worked for me. It’s the mindset.

Scott

See one, do one, teach one - right. I love that, and I can’t say I disagree. It’s not so much a resource you’re missing as a mindset shift that has to happen first, and then you figure out the rest. We’re all smart and resourceful enough to work out how to make it happen.

So, when you transitioned from pure clinical work to clinician-plus-builder - physician innovator, physician builder - was there any imposter syndrome you dealt with, and if so, how did you handle it?

Bart

It happens quite a bit for me, at least. In my family practice, I’m talking with patients many times a day, and I like to treat it as a partnership, even in a very short appointment. I’ll say, listen, I have to be honest, I don’t know. How to help your back pain, or your chronic cough where everything looks fine but you’re still coughing - honestly, I don’t know, and probably nobody else does either. So here’s my suggestion, let’s try this, let’s try that, what do you think. I come out of the room with a real sense of imposter syndrome fairly often, and it actually makes me more humble with my patients.

With the building side, the constant learning has a similar effect - it puts me in my place and makes me aware how early I still am in that whole process, how much is still ahead of me. People who’ve built real companies are so much further ahead, with so much more knowledge and experience. I’m always inspired by a colleague of mine, a spinal surgeon out of Cleveland Clinic who did his residency and fellowship at Rush, who gave up his medical practice entirely to build companies. He’s probably a hundred-million-dollar-plus investor and innovator now. He always inspires me - I look up to him whenever I think about it.

Scott

That’s interesting. It’s good to have that humility about what you’re doing, both medically and as an entrepreneur - sometimes you don’t have all the answers, but that doesn’t mean you can’t try your best, be honest, and figure it out. I like that the humility carries over from the physician side to the builder side.

So these days, with a busy practice seeing 80 patients a day - I read that you handle that panel and you’re home by 5pm every day, working less than 40 hours a week. Is that accurate? How do you make it all fit into one week without overflowing past 5pm?

Bart

It’s actually less than forty. I’ve started cutting my days back further to make room for the building side. I’m also lucky to be in a capitation model, which lets me care for patients remotely and delegate to my staff. At this point I’m working about 25 hours a week, and billing probably four to five times the average family doctor in Ontario. It’s not because I’m smarter or have extra funding - I’ve just organized myself within the existing rules, which is why I feel so confident talking about this. I think there’s enormous unused capacity in how doctors work, and I’d love for any doctor who wants to change how they work to make use of what I’ve built. The capitation model helps, but a lot of it just comes down to how I’m organized.

Scott

Interesting. So if you’re doing 25 hours a week of clinical time and seeing that many patients, is a good chunk of the rest of your week going toward DoctorFlow these days?

Bart

Yes, most of it goes toward DoctorFlow. I’ve hired a few people to help me at this point, which has been a big release. I’m applying the same framework to my company in a way. It’s generating revenue, but it’s not fully self-funding yet - it’s bootstrapped, so whatever I make in my practice, I put toward making it work. It’s an exciting journey. I also have responsibilities with my kids - I take my son to soccer or basketball almost every day of the week, so when I get home, I’m not sitting down, I’m a driver.

Scott

That makes total sense. If you’re building something substantial, you have to spend real energy and time on it, even when you’ve hired people. So the underlying design makes sense - compress your clinical hours, use one chunk for building the business, another chunk for family. If you try to layer business building on top of a 40- or 45-hour clinical week, things burst at the seams - you can only sustain that for so long.

So tell me - where does DoctorFlow go from here? What does it look like in three years? What’s your vision?

Bart

DoctorFlow is designed specifically for very busy outpatient practices seeing a hundred or more patients a day, whether that’s one doctor or several, typically ten-plus rooms. The ideal customer is a busy walk-in clinic or urgent care, with high turnover, a lot of patient movement, and a lot of coordination needed. That’s where it shines. In three years, I see this in about 150 clinics across Canada and the US. The target for this year is 20 to 25. I’m a hundred percent sure it’s a tool that will become very valuable for very busy practices.

Scott

That’s wonderful. I can see this appealing to a physician who wants to keep or even increase their revenue while drastically cutting their hours - freeing up a half day or a full day a week, or at minimum cutting off charting after 5pm to protect family time. Or it could appeal to someone who wants to generate more income from their practice without expanding the hours they work. So those two types of physicians - would you say that’s an accurate way to describe who DoctorFlow is built for?

Bart

Yes. I’d add that it’s for doctors who genuinely want to save every ten seconds of their time. The clearest example is an extreme one: an outpatient doctor seeing 20 patients a day with two rooms has almost nothing to coordinate. Someone seeing a hundred patients a day across seven rooms with a team has a lot to coordinate. Those are the doctors who see the value in ten seconds. That’s actually one of my qualifying questions: if I saved you ten seconds per appointment, would you take it? People who say no probably aren’t the right customer. People who say they’d love ten seconds back on every appointment - that adds up to a lot of minutes in a day - those are my kind of doctor, and I think DoctorFlow works well for them.

Scott

That’s a good distinction. I also read that you founded Landmark Knee this year. What is that, and how does it fit into everything else?

Bart

It’s a company providing a cross-border service for American patients, offering an ultrasound-guided knee injection treatment that’s innovative and not yet available in the United States. It’s a business that leverages a market that doesn’t have access to that treatment yet. Since my location is about five minutes across from Detroit, a lot of patients drive or fly in and drive over. I’m in a central location in the city.

It’s a business that helps fund DoctorFlow - a bridge, in a sense. It’s also been an exciting marketing and sales education for me. I’m learning all the levels of a sales funnel - I have people doing inbound and outbound sales for me, I train them, we practice scripts and objection handling. It’s an amazing training ground for things I wasn’t even aware existed before.

Scott

That’s so interesting. We really don’t get any of that in medical training - the business side of medicine is so new to most physicians, and people tend to learn it by trial by fire once they join a practice and suddenly become responsible for it.

I want to ask you about AI as well, obviously a hot topic for physicians regardless of specialty. From your perspective, what do you think AI changes about the career of a family medicine physician over the next five years, and what does it not change?

Bart

The general predictions aren’t very favorable to you, Scott - radiology is often cited as the first specialty facing real disruption. For family medicine, at this point AI mostly shows up as smarter dictation. I actually welcome patients who research their symptoms and come in saying, ‘here’s what ChatGPT said’ - I like that. It gives us something to briefly connect about, and patients are more informed. I think it will prepare patients better for appointments - maybe we’ll be able to send smarter pre-visit templates so they arrive better prepped, and visits will get shorter, if we use that opportunity well. I don’t see family medicine losing its human connection anytime soon - that’s a huge piece of it. I think AI will be an augmentation, not a replacement.

Scott

Right, that makes a lot of sense. If you could go back to the very beginning of your journey as a physician, what would you tell yourself, if you could start over?

Bart

That’s a good question. I’d tell myself: it’s going to be completely different than you’re thinking. Keep your mind open, and keep investing in yourself, because a whole world of opportunity opens up. It doesn’t necessarily pay you in money - it pays in ideas, in being in a room with interesting people. Getting the chance to meet and talk with you right now is one of the rewards I get from my work, more than anything else. Just keep doing the reps, I think.

Scott

That’s great. Any general advice for physicians thinking about doing something off the default career script - what would you tell physicians who are interested in something beyond the standard, typical practice?

Bart

I’d say this not from the perspective of a business guru, none of that - from the perspective of a student. My advice is that you can learn almost anything from the internet now, which is maybe part of why traditional education is struggling. Just keep an open mind and keep learning. We’re all capable enough to have gotten to where we are, which means we’re capable of learning anything else too. There’s nothing about learning that should be a source of fear for us.

Scott

Wonderful. Is there anything else you wanted to bring up that I haven’t asked about, or that we haven’t covered today?

Bart

I think that’s it. This was really interesting, and I want to say I’m grateful to connect. It’s awesome to be here, and thank you for the opportunity.

Scott

Thanks so much. Bart, if people want to reach out to learn more about you or what you’re working on, where should they go?

Bart

You can find me at DoctorFlow.com - my email is info@doctorflow.com. You can find me on LinkedIn at Dr. Bart Kaczmarek, and on YouTube, where I have a channel about medical office efficiency.

I’d love to connect with people who have questions, who are struggling with how to innovate their medical office, how to regain control of their practice, how to just feel better as doctors. I think we’re in a bit of an identity crisis as a profession - we’re looking for more and not getting it, and that’s a real source of frustration. But we can achieve almost anything within the existing rules.

Scott

Wonderful. Thank you so much. And for those of you who want to learn more about the topics we’ve discussed today, you can visit Physician Vantage Studio and learn more about the mission at PhysicianVantage.com. Thank you very much, Bart - it’s been great speaking with you and learning about your journey, and I wish you all the success going forward.

Bart

Thank you so much. Thank you.

• Scott F. Cameron, MD is a practicing radiologist, AI implementation leader, angel investor, and MRS Past President. He writes about physician career architecture at Physician Vantage Studio.

  Thanks for reading Physician Vantage Studio! Subscribe for free to stay updated with my coming work, including new articles, frameworks, and conversations like this - aimed at helping physicians create expansive, leveraged, and durable careers - while keeping medicine as the foundation.

Dr. Bart Kaczmarek went from urology training to starting over in family medicine, and ultimately to designing a practice that looks almost nothing like the default model - one built around delegation, systems, autonomy, and an almost obsessive search for wasted physician time.

In Part I of our conversation, we trace how he transformed a two-room practice seeing roughly 20 patients a day into a radically different clinical operation, why he believes physicians often hold onto work they should give away, and the CRAFT framework he developed along the way. His story raises a bigger question for any physician who feels constrained by the way medicine is "supposed" to be practiced: how much of your current career could you redesign?

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Physician Vantage Studio - Interview 01 - Dr. Bart Kaczmarek, Family Physician, Founder of DoctorFlow - Part I

Scott

Dr. Bart Kaczmarek, it’s great to speak with you and chat a little bit about your career journey as a physician, as a builder, and an innovator. It’s really nice to speak with you.

Bart

Very nice to be here, Scott. Thank you for having me on Physician Vantage Studio.

Scott

Thanks so much. So tell me a little bit about yourself - who you are and what you do.

Bart

I’m a family physician trained in the US at Henry Ford Hospital in Detroit. Right now I run an independent practice, seeing a lot more patients, more efficiently, than most doctors I know, on a much shorter work week with much higher leverage. Part of what I do is help other physicians discover that same capacity to work easier within the system that already exists. I also founded DoctorFlow, a software company that helps very busy, high-volume doctors turn over and process patients more easily, as well as LandmarkKnee, where I offer innovative treatment for knee pain and knee arthritis to patients from across North America.

Scott

Wonderful. So take me back to the early days of your journey, when you were training. I understand you did medical school overseas, and during that time you founded two music clubs, one of which was voted the best in the country in Poland. Tell me about that origin story - maybe the first time you founded something - and any lessons you learned that carried over to today.

Bart

I think that was the beginning of my journey, and it showed that I’m just curious. When an opportunity went by, I wanted to see what it was and what it might bring. Looking back now, I can see how wobbly and inconsistent those early efforts were - I was chasing shiny objects left and right. But in retrospect, it showed that I’m someone who’s interested and wants to reach for more. If there’s one good thing I take from that first venture, it’s probably that.

Scott

I love that - that innate curiosity from the early days clearly stuck with you as you went further down the road. I also understand that before family medicine, you did a urology residency, which is really interesting - we don’t run into many people who’ve done multiple training programs. Then after the urology residency, you did a robotic surgery fellowship, and after that, you started over in family medicine. Talk to me about that decision and what happened there.

Bart

You know what, I was just living happily in Poland, minding my own business, practicing medicine and trying to build something on the side, like I was describing. Then a woman showed up in my life who turned out to be Canadian - she was in the same medical school I had just graduated from. We didn’t actually meet in medical school; we met at a gym outside of it. We got married, and that brought me to where she was doing her residency, in Atlanta. Then I had to reinvent everything, because whatever training you do overseas doesn’t count here, which is fair - now I understand why, because the training is completely different, and I’m grateful for that second round of work on myself.

I tried to do a urology residency in the States, and one of the ways in was a program at Henry Ford Hospital in Detroit. I volunteered there for two years, then got into what was called a robotic fellowship. It wasn’t really robotic surgery - it was assisting with the robot - but it was basically like being a first-year surgical resident with a pager, assisting wherever I could. It’s a big name, but it was really more of a prelim year in surgery and urology, and that’s what eventually led me to family medicine.

Scott

Interesting. So when you made that transition to family medicine, was there anything you missed - a sense of ‘I wish I could still be doing some of the urology work’? Or did the benefits of family medicine more than compensate for whatever you’d left behind? How did you mentally handle that transition?

Bart

That’s actually an amazing question. It’s something I’m still amazed by - how deeply disappointed I was for a long time, all through residency in family medicine. I felt like I was disappointing myself, my family, all my friends who had done something ‘better’ than family medicine. For years I just felt inadequate, and that was the source of a lot of negative thinking. It wasn’t until recently that I realized something. Throughout my journey, I kept asking myself, what’s the best specialty? Maybe I should do another one. My mind went through all of it - maybe the best specialty is the one that makes the most money, or the one with the most prestige. But I’ve reached what feels like - and this may still change - the most mature answer: the best specialty is the one that gives you the most control. Being in charge of what you do, how you organize your work, how you want to work - completely. And family medicine is actually great for that. So now I’m the opposite of what I used to think. I’m grateful for where I am, because I realized I have this amazing ability to control my work, my fate, and my life.

Scott

I love that perspective. Hearing you talk about it, there’s such a broad spectrum of what you can do within a given specialty, whether that’s family medicine or orthopedics or anything else. Two people practicing the same specialty can look totally different - almost as different as someone doing urology versus dermatology or pediatrics. As you said, it’s the way you do it. It’s what you bring to it, how you set up your practice, and so on.

Bart

Absolutely. In a hospital, your schedule, your procedure rooms - everything is bound to the hospital’s rules and policies. The wiggle room is very minimal. With outpatient medicine, and this is part of why I appreciate it so much, you can rearrange far more than people think. That’s where my ideas and my innovations come from - because once I saw that, I discovered a whole world.

Scott

That’s so interesting. Related to that - would you say that after you finished training and built your own practice in Windsor, control and autonomy were the reasons for going independent and setting up that practice environment?

Bart

Yes. For the first year or two, I was a senior staff physician at Henry Ford, at an outpatient clinic, and for the first few months it felt great - I’m not a resident anymore, I’m in charge of my own schedule, I can tell people what to do. You get this sudden boost of power. But then I realized how limited that actually is. If I got excited about doing more than everyone else, I quickly ran into the limits of the whole system. I’m not saying anything is wrong with that hospital or health system specifically - I think it’s generalized. You’re just limited by the whole structure. You’re in a rut, you have to follow the direction, and there’s very little wiggle room. That’s what attracted me to outpatient practice in Canada - I saw doctors here who looked so much more relaxed, so much more in charge. They’d be biking on the weekends, walking, doing their own thing. I wanted that too. So I went for it.

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Scott

That’s so interesting. I’ve run into physicians like that too, with their own independent outpatient practices, and it’s fascinating how creative they can get with their schedule - blocking off a half day one week, taking a day off another week, really shaping it however they want. So moving forward to 2020 - I read that you took over a two-room practice seeing about 20 patients a day. Tell me what that baseline felt like.

Bart

Coming out of Henry Ford, everything had EMRs, and the buildings were at least spick and span. I might have complained the workflow wasn’t what I wanted, but everything looked nice. Then I walked into this building that looked like the 1950s - paper charts on the desk, like traveling back a hundred years. That was my first impression. I had to implement a local EMR myself. The reason I took over that particular practice is that it was tied to a payment model that was capped, and you had to take over an existing practice to get into that model, rather than starting from scratch. The opportunity was there, but the reality was a bit of a hit, given how far back in time it felt. Two rooms, one barely used, paper charts, and one secretary.

Scott

So a bit of a culture shock in some ways. Then the next year, in 2021, you hired your first nurse, and you’ve said that’s when your after-hours charting disappeared, or became substantially less. How did that work, and what specifically came off your plate when you made that hire?

Bart

I made the hire partly because I was also working at urgent care to support myself, which is a fairly easy thing to start in Ontario when you first move to Canada. I had a nurse there - a newer nurse - who anticipated what I wanted. She was caring, thoughtful, and helpful in ways I hadn’t even asked for. At that moment I thought, if I ever have my own practice, I’m hiring her. And I did. I called her, she agreed, and she still works with me today.

What I delegated started gradually, because in my model I’m stretching the boundaries of the traditional nursing role. My nurses now operate more like nurse practitioners in terms of how much responsibility is on their plate. I started with things like refilling prescriptions under specific guardrails, so I don’t have to look at or sign off on every single one - they start the note for me. Vaccinations, blood pressure checks - when I was at Henry Ford, I used to think, why do I have to be the one taking blood pressures and vitals? You can say it’s only a minute, but it’s a wasted minute. Someone else can do it for a tenth of the pay per hour. Why would the highest-value person in the room be doing low-value work? That always bothered me, so that’s what I started delegating first in my own practice. It seems small, but it took away a lot of the regular headaches of the day, and once you do that, the grind of the visits becomes much lighter.

Scott

That totally makes sense. You were wise to use that person to the upper limits of what they could realistically do, and it sounds like they did quite a bit for you. A lot of doctors hearing this might have a knee-jerk reaction - ‘I can’t afford that, I can’t afford to hire someone.’ What would you say to them, and how does the math actually work out in year one?

Bart

Here’s my biggest example. I think the barrier isn’t logic - it’s emotion. It’s the attachment to the model where you feel you have to do everything. The easiest first move, which I describe step by step in a model I call CRAFT - we can talk about that later - is to release capacity from the doctor. The math is simple. I pay my nurse $25 an hour. Take paperwork as an example: one particularly extreme case is worth about $300 for 30 minutes of filling out a form, which we bill to patients directly. Theoretically that’s a $600-an-hour job. I pay her $25 an hour to do it, and at the same time I’m not doing it myself, which is the real issue for most doctors. A lot of doctors would say, ‘I don’t even want to be paid for that, just take it off my plate’ - and not only do you get that, you also get to play with your kids in the morning, or go fishing, and you still make money.

That’s the main principle. As logical as it is, a lot of my colleagues, when I show them what I do, agree with me logically but can’t get past the idea that the paperwork is theirs - that it has to be their pen checking that box, yes or no. I strongly disagree, and I try to show colleagues from every angle that holding onto it doesn’t make sense logically or emotionally. But emotions are hard to overcome. So doctors have to be ready for that.

Scott

That’s a good point. There’s a lot of emotion and inertia, and an assumption that things have to be done the way they’ve always been done. Unless someone sees a model exemplified, it may not feel intuitive that it’s even possible. But hearing you describe it, it makes total sense - why do paperwork if you don’t have to, and can free up time for higher-value activities or things you enjoy instead? That’s a great use of human leverage.

So eventually you took the clinic from 20 patients a day to 40, then to 80. Tell me how that went - what had to be true at each step before you could add the next set of rooms?

Bart

As I said, I engineered the CRAFT model as more of a reverse-engineering of how I actually progressed. It wasn’t a deliberate plan - it was just what felt intuitive at the time. I kept realizing I needed more capacity, patients were waiting, and eventually I moved to a location that now has about seven rooms plus two procedure rooms. I’ll occasionally use nine rooms, but usually it’s five, six, or seven on a typical day.

A lot of doctors will ask - if you’re seeing 80 people a day, what are you actually doing in the room? What kind of medicine is that? In my case, the quality metrics actually went up, not down. And for the patient, it isn’t a five-minute visit in the way people imagine, because I’ve unbundled outpatient care. I believe about 80 percent of what happens inside the room can be delegated, and close to 100 percent of the work that doesn’t require the physician in the room can be delegated too, and we can still bill for it.

So picture this: I don’t walk in to start the visit, I walk in to finish it. My nurses prep every patient - take blood pressure, do vaccinations, review preventive care, write me a note with the history and details of the concern, list out the concerns, prepare all the documentation. I haven’t touched paperwork in years. Everything is already taken care of, so I walk into an appointment that’s already about 80 percent complete. If a nurse can do that, imagine what a nurse practitioner or physician assistant could do. It’s almost like coming in for the last touch, the way an attending comes in after residents have already worked up the patient. Not exactly that, but close. You don’t need more than about five minutes on average - sometimes I’m there ten or fifteen minutes, but on average it’s a very short appointment because everything is already taken care of. So it’s a very different kind of visit, and a very different kind of 80-patient day, than what most people picture in outpatient medicine.

Scott

That makes a lot of sense. It shouldn’t be framed as you doing everything for every patient - it’s about how you use every member of your team, together with you, to move through that patient panel. It also makes me think about how, the higher you go in a hierarchy, the fewer but more important the decisions are - like how CEOs are said to make only a handful of real decisions a day, and those are the ones that matter. It’s the same for you as a physician. You’re asking, what are the things that only I can and should address in this visit, and what can everyone else on the team handle? If something comes up they’re not sure about, I’d imagine they flag it for you. But everyone understands the goal: take as much off your plate as possible so you can stay mentally clear for the decisions only you can make.

Bart

Absolutely, you’re right on the money. Here’s a story I tell people. I do a lot of joint injections - I practice sports medicine as a family doctor as well - and local doctors refer patients to me for that. There’s no wait time; you can see me within the same week. I do probably 50-plus injections a week, sometimes more.

There’s a funny story I tell about this - we found the lowest-value task in my own workflow, the thing that gave me the most headache, and had someone else take it off my plate. It turned out to be that Band-Aids come individually wrapped in a peel-open packet. So now, once a week, my nurses’ job is to peel open all the Band-Aids ahead of time and put them in every room, so they’re already unwrapped when I come in. It’s a small thing, but it shows how I think about this. A new hire might think, ‘I don’t want to work with this guy,’ and that’s fine, but my team is used to it.

Scott

I love it, I love it.

Scott

That’s so interesting, and it makes me think again about the level of control you have in your practice, being able to tell your assistants, I want you to do this. I actually tried to institute something similar in my own practice. I do joint injections as well, and I told some colleagues, why don’t we have the people assisting us open the sterile packages and set up the sterile field, along with these other small tasks? There was some pushback - a few people said they weren’t sure they trusted someone else doing that. Which, again, gets back to that emotional thing you mentioned, assuming you have to do everything yourself. I said, look, it’s not that complicated - you can have a clear conversation and trust someone with it. But because we wanted one standardized policy for the whole practice, and a few people were uncomfortable, we defaulted to everyone doing it themselves. From my perspective, I was thinking exactly like you - why do I need to be the one unpeeling the wrapper off a syringe? It’s a small thing, but it adds up over the course of a day.

Bart

Yes, absolutely, and I think you’re right - that’s a good example of institutions being a bit of a barrier, because unless you get everyone on board, it’s hard to be the only one doing it differently, and it doesn’t stick. When you have fewer colleagues in the group, or run on your own, the key is to not be the guy who just decides unilaterally and expects everyone to comply. I have a close relationship with my team and we talk often. We hold biweekly huddles where they write on a board what’s bothering them, including things about how I do things. We treat it as problem-centered thinking together - how can we overcome this, how can we make this better, what was an issue for everyone this week. It’s a continuous improvement process, almost automatic at this point - we all see it as, we just have to keep getting better. It’s not that I’m fussy, it’s just the direction we’re taking, and everyone is on the same page about it.

Scott

That makes a lot of sense. So, Bart, take me back to the CRAFT system you mentioned a few minutes ago. You created it and make it available to other physicians so they can learn how to improve the processes in their own practice. Tell me about the different stages in that system.

Bart

CRAFT is an acronym. C is for Clean - prepare everything at zero cost. If you have a practice at any stage and you want to grow it, be more profitable, have fewer headaches, and implement more systems, this is systems-based thinking. It’s like having an old car that barely runs - you might as well clean the outside and pump the tires, because it doesn’t cost you anything. That includes raising all your fees to what you’re legally allowed to charge, going to the higher end of the bracket, being available online for things, creating templates, and more.

R is for Release. That’s the first hire you make outside your secretary, where you start delegating things - starting with the paperwork you get paid for. Releasing that capacity actually reveals hidden capacity that lets you hire the next person. It’s self-funding - one step funds the next. I now run a team of three nurses and three secretaries as a solo doctor. The most common model in Ontario is one doctor running one secretary, often not even a full one, since they’re usually shared. So I’m massively overstaffed by comparison, and a lot of visiting doctors ask, who’s paying for this? I tell them: the efficiency I discovered pays for all of it. I have no extra funding beyond what everyone else has access to.

A is for Assembly - build a better, bigger team that helps you more and more. Once you discover that 80 percent of an appointment can be handled by someone else, you put more patients into that freed-up slot. That’s your next step. Some people choose to see more patients, like I did; others choose to work less and go home earlier. That’s their choice. I took it to the extreme, to see how many patients I could handle, and it’s gone really well.

F is for Flow. At some point, the geometry of your space stops working. For me, two rooms stopped working, then four rooms stopped working - too much backup - so I moved to a clinic I designed myself for efficiency.

T is for Throughput - find a way to measure your bottlenecks and keep improving, both the mechanical systems around scheduling and your team, so things keep getting better.

It’s available for free to everyone at craft.doctorflow.com. I encourage everyone to use it. I’d genuinely be happy if it stayed completely free forever. If more doctors use it, even partially, that’s the mission - I think we can all work better, more efficiently, and regain control over what we do.

Coming up next week in Part II… we’ll learn from Bart about the $250 first version of DoctorFlow, giving up a six-figure paper stake in a business for $1 in order to regain focus, what it’s like now to work roughly 25 clinical hours per week, and Bart's argument for what the real thing holding physicians back is - and a hint - it’s not time or money.

• Scott F. Cameron, MD is a practicing radiologist, AI implementation leader, angel investor, and MRS Past President. He writes about physician career architecture at Physician Vantage Studio.

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Think about a colleague you know who’s been noodling on the same idea for two years. The enthusiasm and curiosity and interest has remained there, as has the lack of actual execution.

This physician is very bright and fully capable, and they’re not exactly paralyzed out of fear. What’s actually stopping them is the sense that they’re contemplating a big irreversible move which will change the trajectory of their entire career. It’s hard to make a decision that big.

But the reality is that you don’t have to redesign or blow up your career before taking a first step.

Small, intentional experiments can produce enough data to propel you forward in the right direction. Thinking about career redesign in this way can become something that’s able to be subject to a test. Let’s look closer at how the right design of an experiment can maintain your clinical foundation while still creating options for expansion. We’ll go over a practical 90-day example template for running a career experiment, and go over what distinguishes a good experiment from a bad one.

First, we have to lay out the false dichotomy between having to choose between two extremes. You’re not limited to either: a) completely leaving your practice, or making a large decision such as pursuing an advanced degree, or starting a company, versus b) staying stagnant in the same professional location and with the same role.

When you have a lingering curiosity about something, whether that happens to be entrepreneurship, investing, AI, or something else, the challenge is how you take that interest and translate it into a manageable, actionable step without feeling that you need a complete upheaval of your career. This gap between your signal of persistent curiosity and your demand for a complete career path is where many physicians get stuck.

The Gravitational Pull That Keeps Physicians Still

Some of the reasons why physicians lean towards a strong and abrupt career change make sense. For one, as physicians we tend to want certainty before we take action. Our clinical training and clinical practice awards certainty and precision and advises us to reduce ambiguity and uncertainty. This mindset is great for keeping patients alive and healthy and minimizing errors, but ends up being artificially restrictive when it comes to career experimentation and redesign.

Additionally, the realities of what is the best fit for you often can’t be answered through introspection alone, but through hands-on application and experimentation.

Another reason is that medical training tends to be built around large structured decisions such as what specialty to train in, where to do your fellowship, what type of practice to join, etc. And so physicians become used to these large, structured commitments as opposed to smaller reversible trials. As mentioned previously, a physician’s sense of identity can also restrict experimentation as it tends to threaten what you’ve worked so hard to build. And lastly, physicians tend to over-inflate the cost of trying, assuming that it will require a formal title, credential, a large audience or following, significant capital, or reduced clinical work. In many cases, if your experiment is designed well enough it won’t require any of those.

What is a career experiment? It’s a time-bounded, risk-bounded, small action which has the intent of producing information that will help you guide your future direction.

The main purpose of the experiment isn’t immediately to generate income or prestige or certainty, but rather to generate a small amount of data and evidence. What you actually want to get back is some form of feedback indicating whether you like the type of work that you started doing, whether you find it valuable, and whether you want to become known for that type of work. In running the experiment, you’ll get a sense of whether it fits with your purpose and identity, and it will also inform you as to what other types of skills or experience or relationships you would need to add. You’ll get a sense of the true fit with your underlying central thesis. Ultimately, you’re seeking clarity and better signal, all of which will inform your next steps.

Instead of predicting the future, learn your way into it through a career experiment.

The Architecture of the Experiment

In terms of duration, the ideal career experiment is 90 days in length. This is long enough that you can get some genuine feedback and data and help you overcome the initial uncomfortable first few weeks. But it’s short enough that it triggers a reflection and review before forcing you to be part of a longer-term commitment that’s not the best fit. It doesn’t have to be 90 days, but this provides a clean demarcation point. Alternatives include one bounded project or deliverable, or one committee term.

The experiment should also be structured so that it has low downside risk. It will ideally have little to no financial downside, and it will minimally impact your personal and family obligations. Most likely it will have little to no impact on your professional reputation and clinical skill set.

It also needs to be specific and prompt action: for example, instead of saying “learn about startups” the concrete action would be “talk to four digital health founders”. It should generate evidence and you should be able to document that evidence so that you can refer to it and analyze it. Make note of how you were able to function in this experiment, the relationships that formed, and your sense of the strategic fit with the bigger picture of what you’re trying to do. Remember, try to align this with your central thesis instead of being a random activity that you’re adding on. And ideally it should provide you with the opportunity to build upon it when it comes to its end, if you should so choose. But also realize that if you stop, it doesn’t imply that the experiment failed, it just means that you learned what you don’t want to pursue.

Examples of Career Experiments

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Tangible Steps For Running the Career Experiment

1. Notice the Signal - What have you been persistently curious about? What has been frustrating you for a long time? And what are the things that provide energy, swings, or recurring interest?

2. Create a Hypothesis - Get specific about what you want to build or test.

3. Find the Smallest Possible Test - Resist the urge to have a grandiose project, but at the same time have a test large enough that will generate data, but small enough that you can complete it within 90 days.

4. Execute the Experiment - Put on your calendar a start date and an end date, the actual scope of the project, and what time blocks you will use to run the experiment.

5. Capture Return Signal - Write down data relating to how you were able to execute on the project, your energy level, the relationships formed, any inbound opportunities that came from it, and generally how you feel it aligned with your expectations.

6. Decide - Make a decision at the end of the 90 days as to whether you’re going to continue with more activity that is along the same lines as your experiment, and if so, how you will expand the scope or formalize it, or decide if you’re going to repeat the experiment again, or if you’re going to stop entirely.

7. Reinvest the Learning - Start a new experiment, but this time from a stronger baseline.

Failure Modes to Avoid

Make sure to avoid some of the common failure modes. One of these is making the experiment too large. The examples of this would be enrolling in a long or costly degree program, quitting your job and starting a company, or reducing your clinical work before you test the demand for the thing that you’re building. Make sure you’re only running one experiment at a time so that you can actually gauge process and outcomes. Make sure you prioritize learning over prestige and income; avoid the urge to tack on another side hustle for the sake of it or for the sake of income. Also remember that a title, while impressive, doesn’t necessarily produce forward momentum in the direction that you want to go. Also, manage your expectations regarding financial returns as you may not capture any income from this first experiment and the returns will accrue to you in the form of credibility, relationships, introductions, and knowledge.

Make sure to define an endpoint or at least a point in time in which you will check in with yourself and assess how the experiment aligned with your intentions. Lastly, remember that negative evidence doesn’t necessarily mean that there was a personal failure. There might have been an issue with your hypothesis, the scope of the project, the format, or any number of factors.

Even if the experiment doesn’t work or doesn’t become a permanent part of your larger body of work, it still provides useful data and can provide a new source of leverage. This is because you’ll have built up more knowledge, more relationships, and a better overall point of view. You may end up with a result that comes out of it that includes a publication or presentation, a speaking topic, or even just greater market understanding. Perhaps the most important of the things that will come is clarity about what to pursue and what not to pursue.

Ultimately, the key to moving forward in your professional discovery and redesign is that you don’t have to choose a specific future before acting. You actually create this future through making a hypothesis, running an experiment, testing, observing and gathering data, iterating, refining, and running the next experiment.

You don’t need a 10-year roadmap to start. You need a general direction, your best effort at a thesis, and a well-designed 90 day experiment.

So for the physician at the outset who had been pondering whether to pull the trigger on the idea they’d been mulling over for two years, the reality is that they don’t need to quit their practice, make a grand announcement, or enroll in a costly degree program. They need to articulate a good question and lay out a precise small test to run.

What professional decision have you been postponing because it feels like an all-or-none decision? What 90-day experiment could you design and run without abandoning your clinical work that would provide you with useful data? Let me know in the comments.

• Scott F. Cameron, MD is a practicing radiologist, AI implementation leader, angel investor, and MRS Past President. He writes about physician career architecture at Physician Vantage Studio.

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Think about two of your former co-residents.

They finished the same training program at the same time, and both were very smart and capable. Fast forward 15 years, and one of them has a conventional career by all metrics: well respected in the community, doing well financially, and with great patient reviews. A success by anyone’s standards.

The second one, on the other hand, has created something that would take a paragraph to describe. On top of clinical medicine, she has created innovative training and mentoring programs at her institution, served as chair of society leadership committees, worked on nonprofit initiatives, become a prolific writer, and made multiple media appearances.

They had the same starting line but very different destinations.

How and why does this happen?

The underlying reason for this doesn’t have to do with luck, abandoning medicine, or being wired differently than the rest of us.

These physicians are certainly intelligent and ambitious. But what often happens is that they made a small number of different choices: choices about how they saw themselves and what they were capable of, how they saw their career, what they decided to focus on, and what they said yes to and intentionally said no to.

Made consistently over a long time horizon, these decisions helped forge the fascinating physician.

Before we get any deeper, let’s define more specifically what fascinating means.

Because a fascinating career isn’t necessarily characterized by fame, followers, ultra-high income, prestige, or a move into non-clinical work.

Fascinating doesn’t necessarily mean the most exceptionally talented MDs and DOs, and it also doesn’t mean leaving clinical medicine. In fact, physicians who keep clinical work at the foundation and build something larger around it often create the most fascinating careers.

It’s also not about fame. Many interesting careers are almost invisible to anyone outside a particular professional community. For example, think about the cardiologist who advises AI startups, founded his own company, and serves as a venture partner: he may not be famous, but his career is certainly fascinating.

Ultimately, what makes a career fascinating is that it sparks curiosity in other physicians. It’s been pointing in a clear direction for a period of time, and it shows accumulation rather than repetition or mere piling on of activities. And it’s one in which the physician uses medicine as a foundation and strategic leverage point, rather than as the ceiling.

A fascinating career is one that thoughtful physicians are legitimately curious about. Not envious of or confused by - but curious about.

That curiosity is the strongest resonant signal.

Myths of the Fascinating Physician

There are a few myths about what these physicians have in common, and most of those assumptions are incorrect.

The first myth is that these physicians simply had great timing or great luck. Conceding that some elements of luck and timing are always at play, the reality is that the physician who puts herself into interesting places and interesting conversations is not merely getting lucky. She is increasing the surface area for luck.

One CEO I talked to called this ‘creating your own luck’. These physicians are making choices about where they should show up and how they should spend their time and attention. This is primarily strategic preparation and positioning, which create the preconditions that increase the chances of luck.

The second myth is that these individuals must have made some great sacrifice. They must have given up their personal life, or stepped away from medicine, to build something interesting. This is one of the most strongly held beliefs physicians have about other physicians who have built fascinating careers. And it’s also mostly not true. These fascinating physician archetypes have rarely left clinical medicine. Instead, they are using to access healthcare-adjacent opportunities and as the anchor for different activities they are building around it. Certainly, in many cases they have to re-design their clinical work - this could be going part time, or it could be creating an atypical schedule to allow for time to do other activities. But ultimately choosing between professional achievement or a personal life is a false dichotomy when thinking about becoming a fascinating physician.

The third myth is that these physicians are inherently predisposed - maybe they have a particular personality, or maybe they happen to be more creative or better connected.

But the main difference is usually an orientation and action difference, not an intrinsic personality difference. They just think about opportunities and costs, their relationship to time, and the potential outcomes of these decisions in a different way. This type of perspective is something anyone can adapt and use.

The Underlying Signature Patterns

Let’s take a closer look at these fascinating physician careers and see what type of signature they have - what type of pattern underlies these career arcs.

First, they tackled one opportunity that was outside of the regular scope of their daily practice, and it had a tangible result.

This first moment - you could call it a ‘hinge’ moment - may not have been a large, grand gesture, but it was something specific and distinctive that resulted from the physician saying ‘yes’ to an opportunity they thought of - yes to a leadership role, yes to volunteering on a task force or committee, yes to co-writing an article.

What followed was likely not a sharp shift in their day-to-day, but it did make the activation energy to walk through that next door a little bit lower. It made it a little easier to say yes to the follow-up opportunity.

Along with this, they likely held an ‘experimentation framework’ as an approach to their career design, similar to an artist experimenting on the canvas. This is likely the biggest orientation contrast with these physicians compared to their peers.

While most physicians think of the path as fairly rigid, prescriptive, and fixed, these fascinating physicians default to action and experimentation. They actually think about the next 5, 10, or 15 years ahead of them as wide-open, instead of pre-determined benchmarks and milestones that they’ll hit.

They also generally built something interesting, notable, or impactful outside of their clinical work at their institution. Whether it’s a multi-institutional collaborative workgroup, whether it’s a digital health startup, whether it’s an online educational course - it’s something they can point to outside of being an excellent physician at their practice. This is what makes them broadly visible, and able to pull in future opportunities - think about platform leverage, mentioned in one of the prior essays on the Five Forms of Physician Leverage.

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Another trait is that they developed and maintained a central thesis about what they were working on and where they wanted to go. They don’t necessarily have a fully mapped out five to ten year plan, but they should at least have an internal sentence or two about the through line: the oncologist who decided on a ‘mission of educating patients about the cancer-care journey and how to best navigate the system, by speaking, podcasting, writing, and publishing’. The pediatrician whose thesis is around ‘how to help busy working parents navigate behavioral issues with their kids’. This conceptualized thesis creates a filter that lets them say yes or no to opportunities as they become visible. Without this underlying orientation, the same amount of activity and energy produces a long resume - which can certainly be impressive, but there’s a lot of noise, and not necessarily compounding growth. With it, the activities build a portfolio.

Lastly, they have this underlying trait of curiosity, including about adjacent domains.

They talk to people in adjacent industries. They read broadly. They have an interest in how AI gets developed, how policy gets made, or how healthcare startups operate. They don’t necessarily plan to do all of these things, but they have an underlying innate curiosity about how all of the different elements are related to each other.

One aspect tying together all the patterns mentioned above is the different relationship with time that these physicians have. These physicians building these fascinating careers aren’t necessarily ones that are able to work more efficiently or work harder or achieve outcomes at a faster rate. But they understand that they’re playing a long-term game. They started creating something at age 37 that’s now paying dividends at age 47.

They had conversations at a conference that became useful five to seven years later. They wrote an article that was initially read by five people, then 50, then 500.

Most physicians, by contrast, tend to focus on shorter time horizons and play a shorter game. There are a lot of structural reasons for this. The clinical day is demanding and requires immediate, full attention. RVU targets tend to be monthly or quarterly. Performance reviews are biannual or annual. We’re forced in many ways to break down time into short intervals. But the physicians who create fascinating careers also look critically at the longer arc. They understand the long game while still playing the short game. That longer game runs in the background. It is something they patiently build toward, slowly and progressively, without needing it to pay out in the next quarter.

The compounding of a fascinating career is almost never visible in year one or year two. It needs time. It becomes visible in year seven or year ten.

The physicians who created it started earlier than you think, with less than you think.

Factors Spurring the Proliferation of Fascinating Physicians

The underlying differences between these two types of physicians have existed for a very long time. What has changed recently is a set of structural factors that accelerate and scale the process.

One of these forces is market pull.

Startups, including medtech, health tech, AI companies, and value-based care organizations, are creating real paid demand for physicians to serve as co-founders, consultants, board members, and advisors. The need for this is increasing over time.

Another force is that distribution is now free or nearly free.

Writing, speaking, podcasting, and other avenues of visibility require little to no capital, and they do not sit behind a permission gate. Physicians who want to make their opinions visible can now do so. The cost today is time, consistency, and energy, not capital or access.

Lastly, the model is becoming increasingly visible and increasingly named.

This might be one of the biggest structural changes this entire series is trying to make. We are seeing the emergence of the portfolio physician: the physician who has built a fascinating career by design.

When thinking about how to begin transforming your own career into something more interesting, start with your underlying thesis, if you have one.

If you had to choose a single cohesive statement to explain the different activities you have participated in so far in your career, what would that sentence or two be?

If you do not have the answer yet, that’s okay. At least start to think about it. Consider which pieces of your career so far have been most resonant and which ones you want to build upon.

But you have to start by asking the question and developing your best working answer.

Next, find the one adjacent yes.

There is usually a specific hinge moment where you can take a step into something healthcare-adjacent and explore it with a relatively limited investment of time and effort. This may be a leadership role. It could be committee involvement. It could be an article series you want to launch. It could be a discussion with someone who is doing things you want to do. Take a step in that direction and see what you can explore.

Remember, there will likely not be a huge dramatic change after starting with one adjacent yes. There isn’t a quick payout or monumental shift early in the process. Think of the journey in terms of years instead of weeks. The journey is something many physicians can take, but you have to be willing to spend the time and stack these different choices on top of one another.

Fascinating physician careers are accessible to more physicians than we realize. They’re built over a long time horizon. They start with small, unassuming departures from the normal road and the commitment to keep walking when you feel a resonant thesis developing.

I’m curious who comes to mind when you read this - a physician you know whose career generates that genuine curiosity in you. What do you think they did differently? I’d like to know what you noticed, let me know in the comments.

• Scott F. Cameron, MD is a practicing radiologist, AI implementation leader, angel investor, and MRS Past President. He writes about physician career architecture at Physician Vantage Studio.

  Thanks for reading Physician Vantage Studio! Subscribe for free to stay updated with all of my upcoming work.

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There are a few physicians I know personally whose careers are absolutely fascinating to me. What makes them so interesting is that they are multidimensional and rich in variety, and yet, taken as a whole, their careers are far more powerful than the sum of their parts.

The first is a physician I met when I first became involved with the Massachusetts Radiological Society about a decade ago. She started out with relatively humble beginnings as a young attending with some leadership roles in her radiology department. Over time, she gradually added additional leadership roles within her institution and with the American College of Radiology, and then began layering on experiences with different startups in consulting and advisory roles. Ultimately, she shifted away from academic medicine and now serves as the Chief Medical Officer of the Enterprise Imaging Division of a large healthcare company.

Another physician has built a distinctive career spanning clinical practice, healthcare AI, entrepreneurship, and investing. After leading major AI strategy and implementation efforts within a large health system, she founded a healthcare technology company focused on improving care coordination in underserved communities. She also invests in and advises healthcare AI companies, using her clinical and operational experience to influence care at scale.

It’s tempting to look at these individuals and assume there must have been a lucky break or some magic formula that enabled them to achieve such rare success and become the people who are always offered opportunities. While acknowledging the effort, intelligence, and small amount of luck required to achieve these outcomes, we also have to realize that these fascinating careers are not the result of one moment in time.

Rather, they represent what happens when the Physician Leverage Flywheel has years to compound.

None of this happened purely by luck or at one moment in time.

The flywheel represents the system through which physician knowledge and expertise, visibility, relationships and network, opportunities, and capital all reinforce one another. This is how a physician career moves from linear effort to compounding leverage.

What is a Flywheel, exactly?

From a physics perspective, a flywheel is a heavy rotating mechanical device that stores excess kinetic energy. Because a flywheel resists changes to its current state of motion, it absorbs excess energy during power surges and releases it during power drops. This is why the flywheel is difficult to move at first, but with each subsequent turn, the next turn becomes easier. Each turn stores momentum.

This has parallels with a physician career: the early turns feel very difficult, almost as if they are not amounting to anything, while the later turns become far easier once the benefits of the prior turns have accumulated.

Keep in mind, though, that the flywheel isn’t a linear ladder where you leave each rung behind as you climb. The flywheel is circular, with each component feeding back into the others. It’s also not a hustle asking for more hours. It asks for the same effort to be sequenced so that each turn builds upon the next, rather than starting over from the beginning. And it’s not a list of unrelated and uncorrelated activities.

The Physician Leverage Flywheel is a loop of activities that compounds: knowledge becomes credibility, credibility becomes relationships, relationships become opportunity and platform visibility, and opportunity becomes the capital and learning that fund the next turn.

The difference between this dynamic model and a static model, in which you simply accumulate each of those assets independently, is that the dynamic model shows what happens when the assets begin interacting. The Five Forms of Physician Leverage are the parts. The Portfolio Physician Model showed what a good collection of those parts looks like. The flywheel is the motion underneath both - it is what actually connects the parts to each other instead of letting them sit side by side.

The Four Turns of The Flywheel

Here is how that motion actually works. The Physician Leverage Flywheel turns through four moves, and each one should be thought of by name: creation, attraction, compounding, and reinvesting.

Creation is the central thesis come to life, starting with the clinical anchor: the accumulated knowledge, trust, and judgment that grounds everything else, plus a small, bounded experiment built on top of it. The experiment produces knowledge - data and feedback that create insight and judgment - and that insight becomes an output: an article, a presentation, a project, a conference talk, a conversation. It’s essentially something visible that didn’t exist before.

Attraction is what happens once that visible object exists. Once people are able to see what you are thinking about and working on, some of them respond: they connect with you, make an introduction, or bring you an opportunity you did not go looking for.

Compounding is the result of what an engaged network does with that attention. The opportunities start to enhance each other - whether an invitation to speak, an advisory role, a consulting arrangement, a chance to invest, or a new professional path altogether. Each one deepens into credibility and capital: new relationships, access to capital, social proof, authority, income, or equity.

Reinvesting closes the loop. The feedback you get back, what people say, who they introduce you to, and what they ask for next, all tell you whether what you built is working and how to adjust the next turn. The next experiment starts from a stronger, more informed, better-positioned baseline than the last one did.

One full turn from my own life relates to the evolution of my involvement in AI projects and AI initiatives.

The creation turn began with reading radiology journals to learn which AI algorithms were already available in the market and which were in development, then formal coursework followed - the Radiological Society of North America Imaging AI Fundamentals course - so I would have a working baseline for evaluating, implementing, and monitoring AI software in clinical practice.

The attraction turn arrived from two directions at once: joining an angel investing group that invested in healthcare startups, and having them look to me for advice on healthcare companies building with AI. Additionally, I was asked by my department leadership, who knew of my interest in AI, to serve as clinical champion for our department’s initial AI software search and deployment. Both were people noticing a visible interest and pulling me toward them.

The compounding turn is where those two threads turned into real roles. The angel investing group led to advisory invitations from AI and healthcare companies and a few opportunities to invest. The clinical champion role led to a seat on our Institutional AI Advisory Board, where we evaluate AI solutions for the organization.

The reinvesting turn is still running. The Advisory Board seat has led to other downstream introductions and opportunities, including a recent invitation to be interviewed for perspectives on the challenges leaders are facing in the age of AI implementation, which is intended to ultimately be published into a book. All of this credibility and authority now feeds the next round of projects and opportunities, including this one.

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Why is it so hard for physicians to start turning this flywheel?

One reason is intimidation or overwhelm about where to begin: it’s easy to look at examples like these and think, how would I ever do enough to get there? Adding to this, many physicians wait for a sense of permission before taking action, assuming someone else must give them a signal that they are allowed to begin.

Another reason is that many physicians keep their knowledge and achievements private. They have a reflexive reservation about exposing their ideas, and as a result, those thoughts never become visible outputs that the creation turn depends on.

Another reason is that physicians over-index on credentials and under-index on signal. Your CV is a living record of what you’ve already done. If you don’t talk about it, or about what you want to do next, you send no signal into the world about what you’re becoming. This is also where isolated opportunities get lost: a committee role, a side job, or a speaking invitation can each look like progress without tying into a larger thesis, which is another way busyness gets mistaken for leverage.

One of the biggest risks is quitting before the signs of success appear. This is especially challenging because there may not be a true blueprint to know how long you should work before getting those early successes. The first few turns of the flywheel will be hard, and it might feel like you’re doing it alone and with no reward. Stopping before the compounding has had a chance to prove itself and store momentum is one of the main failure modes.

Lastly, letting the clinical foundation slip away is another way that the flywheel can fall apart. All of the initial momentum and progress is put in motion from the basis of the clinical work, and letting that central anchor slip away can undermine the credibility that began those initial turns of the flywheel.

How to Begin Turning the Flywheel

Start with something that has a low activation energy, something accessible from where you are today. For example, writing, building, or creating something visible that doesn’t require anyone else’s approval are good starting points. Something where you don’t need to see signal back immediately is also a strong choice. These examples might be better than an advisory role or something requiring a substantial amount of capital, both of which depend on someone else’s approval.

Make sure you focus on turning one flywheel and not several simultaneously. Pick a single starting point, aligned with your central thesis, and let it run its full course before starting a second flywheel. This allows you to focus your energy and give the first flywheel time to store its energy, compound, and run its course.

Manage your expectations. Little to no signal in the early stages is expected. Keep track of the process and the loop itself, while keeping tabs on the outcome as well, so that the underlying mechanism stays visible even if the return signal isn’t there yet.

Once you start to look for the return signal, here are a few things to pay attention to:

Are people repeating your terms, language, and concepts unprompted? Are colleagues or readers making introductions to others, and are they thinking about you when opportunities come across their radar? Are you beginning to receive inbound requests for collaborations, partnerships, writing, or speaking, all without you asking? Do you notice that you’re having an easier time filtering opportunities and saying no to the wrong ones, because they just add work without compounding or without resonating with your central thesis? Is your work being discussed and forwarded beyond the people that you directly know? These shifts indicate that opportunities are starting to align with the direction that you desire to go, above and beyond pure attention that’s coming to you.

One more thing about time. The turns compound rather than simply add up, so a wheel with twenty years left to turn is not just accumulating more turns than one with five, each turn is increasing what the next one is worth. That means starting matters more than starting big, and it means the wheel doesn’t care how old you are when you give it its first push.

When you see an impressive, multifaceted career, remember:

What looks like luck from the outside is often a flywheel that has had years to work from the inside.

You are probably looking at the fifth turn of the wheel that someone has been quietly pushing since the first.

Physicians don’t need to do more things - they need to realize that they have more leverage than they’re aware of, but most of it is potential and latent leverage until it is connected.

The Physician Leverage Flywheel is that connection. It’s the engine that takes the holdings you already have access to and connects them to the network you already have.

If you are in the middle of a dry spell right now, tell me which turn you think you’re on: creation, attraction, compounding, or reinvesting. I’d be interested to know where the wheel feels stuck.

• Scott F. Cameron, MD is a practicing radiologist, AI implementation leader, angel investor, and MRS Past President. He writes about physician career architecture at Physician Vantage Studio.

  Thanks for reading Physician Vantage Studio! Subscribe for free to stay updated with my upcoming work.

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A handful of years ago, I was quietly searching online job boards after the workday was done, looking for a change. I talked to recruiters, browsed postings, and touched base with colleagues at other institutions - the usual methods. None of it led anywhere interesting.

The way I learned about my next opportunity was from talking to a physician who also served with me on a statewide quality and safety committee. It just came up in casual conversation at the beginning of one of the meetings, when people were just settling in, and I asked him where he practiced and how he liked it. It turned out that there was a whole different type of practice structure in my geographic area that I had no idea existed - a multispecialty outpatient practice, one which would allow me to read similar types of cases and perform similar procedures compared to my current private practice, but with different workplace settings and hours, as well as a few other key differences. Long story short, I ended up joining his practice a little while later - Atrius Health - and it’s the exact one that I practice at today.

This led me to the realization that a physician could spend a lot of time searching online for the right job, role, or opportunity, without realizing that the best opportunities often travel through networks of people - human one-to-one connections - not online databases.

This revealed a truth that I understand today. Physicians often underappreciate the multifaceted relationships they currently have and the ways in which they can activate them. They tend to think about their network the way you’d think about an iceberg: the visible part - the referring physicians, the current colleagues, the people you’d call this week - is all they see. But below the waterline sits something much larger and almost entirely unappreciated: the full decade or more of medical school classmates, former co-residents and fellows, former attendings, conference contacts, and colleagues who left clinical medicine entirely and now serve inside health systems, venture, or industry. Most physicians can describe the visible part of the iceberg in detail but haven’t mapped the rest. The better way to think of the network is as a wide system of context, trust, and visibility that can allow opportunities to come to them.

Many physicians get really uncomfortable with the word ‘network’ or ‘networking’, and for good reason. But it’s important to understand that the network is really a set of relationships where information, introductions, reputation, and opportunities can travel, not merely a pool of people from which to extract favors when they’re needed. This network includes immediate strong ties, weak ties, and adjacent and tangential ties. Importantly, it’s not just about who you know but also who knows you - what do other people know you for? When your name is mentioned, what comes to mind for people? What do they think that you’re capable of, what do they think that you’re curious about, and what do they think that you spend your time on? Network leverage starts to form when people can connect your abilities to a specific opportunity.

The network shouldn’t be thought about as something that’s directly related to your popularity or how well known you are on social media, or even if you’re constantly visible or not. We should move towards thinking about the network as a source of quality connections where there’s some type of context, trust, and a reason to re-engage down the line. In this way, the network doesn’t get conceptualized as a promotional tool, but something in which there’s a mutual exchange of value and a sharing of curiosity.

And it’s often the most distant connections - the ones you’d be tempted to discount - that have the most potential opportunity. The classmate you haven’t spoken to in ages, now a VP at a health system, connects you to a world your immediate colleagues simply can’t. Research on professional networks consistently shows that these dormant, weak ties are disproportionately valuable precisely because they bring you into rooms your inner circle never touches.

Structural reasons why physicians tend to underestimate their networks

One central reason is that the training rewards competence and adherence to rules, more than visibility and network building. Clinical training, after all, rewards individual excellence: you’re evaluated by your knowledge and judgment, and not necessarily by the deliberate cultivation of your network. Another reason is that many physicians are at an inherent disadvantage if they spend most of their time inside their institutional walls and they don’t spread their message more broadly at conferences, other speaking events, or online. If you have an excellent reputation locally, that doesn’t necessarily translate to a wider network where people may understand your credibility and skills.

Also, making an ask (from a networking perspective) can feel uncomfortable. This is because physicians are used to a position of authority and being the ones who are being asked. And so it can sometimes feel uncomfortable to project the ambition or desire for a bigger path if one reaches out to their network. Physicians also tend to be more to themselves as opposed to more broadly visible. As they may reflexively guard against self-promotion, they could unintentionally keep their budding interests and skills more quiet.

Finally, the significant busyness of most practicing clinicians can erode relationships that have formed over time. When your calendar is completely full and you gradually lose touch with colleagues that you trained with or you practiced with in the past, the opportunities that used to trickle in can slow, since no one is kept up to date on what’s happening in your life. Maintaining relationships takes time, which can be in genuine short supply as a busy physician.

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Most physicians already hold several network assets that have quietly gone dark from underuse.

One of the most valuable of these assets is trust and credibility. As a physician, people generally believe you’re competent, serious, and worthy. This is hard for anyone in society to generate, and physicians already tend to have this at baseline. Another inherent advantage is proximity to different opportunities, many of which are not widely advertised. They move through trusted networks first.

Another asset is your context. People will recognize your specialty, where you practice, the prestige and reputation that goes along with it, what your judgment tends to be, and also what interests you have been vocal about in the past. This type of context helps people understand what opportunities to send your way.

Another network asset is distribution, where your network can help you spread the word about important initiatives that you’re working on by forwarding your writing or bringing up your name in the right circles. Finally, another key asset is translation, where people in healthcare-adjacent fields can translate your credibility into advisory, startup, consulting, AI, or leadership opportunities.

Something even more fundamental exists however that most physicians don’t consciously think about: the trust multiplier. Physician outreach to another physician - or even to an industry leader or founder - starts from a credibility baseline that a cold contact just doesn’t have. The shared training, the shared stakes, and the credential itself all silently vouch for you before you’ve said anything. A peer-to-peer message from one physician to another gets answered at rates most professional outreach doesn’t hit, not because of communication prowess, but because of what that white coat signals.

This makes a difference because the trust multiplier exists specifically because of the clinical identity. The network isn’t a separate skill unrelated to medicine - it’s a downstream byproduct of the clinical credential. Every year of training and practice deposited trust into the bank of these relationships, and that trust is there, waiting to be seen and used. This turns “you have more contacts than you remember” from a pep talk into a legitimate leverage argument.

Your network is more nuanced than a single entity - you actually have several, each creating different types of opportunity. Your clinical peers - colleagues, referring physicians, multidisciplinary tumor board peers - carry the strongest trust, but the least expansion potential. Your training network, including medical school classmates, former co-residents and fellows, and mentors, is often dormant but emotionally durable, and the easiest to reactivate with a single message. Your institutional network - administrators, leadership teams, and committee members - create internal leverage. And then there are two networks most physicians barely think about: the adjacent ecosystem of investors, consultants, founders, and AI builders who are healthcare-adjacent, and the audience and community network of readers, subscribers, and online connections where platform leverage and network leverage merge and integrate.

Examples of the Networks in Practice

These multiple networks can work together in the following way, with the end result being that your credibility travels to someone distant from you.

First, it could start with you writing on a subject of importance to you, such as your views on the healthcare workforce crisis. This writing could then be noticed by someone who makes the mental link between that problem and your opinions and potential solutions. When that person later on has a subsequent conversation about that very same issue, they think about you and bring your name up. This then transfers your credibility to a new opportunity.

And the subsequent time that you write and send a signal out there, it becomes easier for it to transfer because your network now understands a little bit better about what to listen for.

So the initial writing created that signal telling your network what you’re thinking about before you’ve ever asked for anything. The later conversations create specificity about a particular opportunity - where your credibility and skill can transfer.

These introductions over time increase the number of people who know you and can imagine an opportunity for you. Your reputation and credibility compound when different people repeat the same ideas and phrases about you. Ultimately, as long as you’re known for something valuable by the right people, your network leverage is doing its job; it’s not necessary to be known by everyone everywhere.

Practical Implementation

Here’s a useful exercise to try in a single sitting - which should take fifteen minutes and a piece of paper. Write down five names per bucket across these five categories:

• Clinical peers who have a high opinion of you

• Former physician contacts from training who would remember you favorably

• People who’ve seen you teach, create something, lead, advise, or solve a problem

• Adjacent professionals from outside your clinical practice

• People who you would just enjoy reconnecting with just for its own sake

Take that list in front of you, and notice three things about it:

1. Do they know what I’m currently working on, and where I hope to go with it?

2. What could I offer them that’s of value - any introduction, information, opportunity, or encouragement?

3. What people or problems may they have visibility into, that I don’t?

Then, when you’re ready to engage with them, send a short, friendly re-introduction. You could give a quick update on what you’ve been working on recently and any relevant updates. Share any recent article that you’ve written - or an impactful one that you’ve read. Let them know about the success of a project that you’re working on, or even a detail about someone you met that might be mutually interesting to them.

Try to make it easy for them to conceptualize you and understand you by using simple, clear language, such as, “I’m working on implementation of new AI software in my practice.” Then use your curiosity about the other person and ask them what projects they’re working on. Doing this in small pieces, week by week over time, is more impactful over the long term, than trying to chunk this all into one heroic effort at one time point during the quarter. Ultimately, see if you can trend towards bringing people together into some sort of gathering - online discussion groups, in-person dinner events, informal get-togethers that bookend conferences. These have the strongest long term impact, and over time, your network gets to understand who you are and what you stand for. When people think of you, they think of a clear idea - and the physician behind it.

Once a physician begins to activate their network, the next question is how these assets compound over time. That is exactly the question that I’ll tackle in detail in the next essay. It’s about the Physician Leverage Flywheel, where knowledge, credibility, network, platform, capital, and opportunity feed one another.

Take a few minutes this week and write down a name you haven’t thought of in years. Look up what they’re doing now. Reply and tell me who came up for you - I’d love to know what you find.

Scott F. Cameron, MD is a practicing radiologist, AI implementation leader, angel investor, and MRS Past President. He writes about physician career architecture at Physician Vantage Studio.

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You’re sitting in the front few rows of the conference room at your specialties annual meeting. On the stage sits a physician who is being introduced by the moderator who stands at the lectern. As you sip your coffee in preparation for the talk, the introduction for the speaker starts in an unassuming way, with the moderator noting the speaker’s expertise in a certain domain. Then, the description starts to unravel in a very interesting way - you start to learn that the speaker has advised numerous startups, they have created a nonprofit, and they are involved in local volunteer efforts. The list of activities goes on and on, to the extent that you think to yourself, this person must have left clinical medicine. However, at the very end of the description, the moderator mentions that the speaker still practices clinical medicine at their institution. Taking another sip of coffee, you lean back in amazement, eagerly awaiting the speaker’s presentation.

I’m sure many of us have experienced this moment. And frankly, this type of speaker introduction is becoming more common. The reality is that a new kind of physician is emerging, one that builds a portfolio of complementary roles and interests that is anchored by their clinical work, as opposed to a single job held for 30 years. The narrow track that serves as the default is being gradually replaced by a multidimensional, multifaceted physician who has created their own blueprint as a practicing physician: the Portfolio Physician.

The portfolio physician is designing a broader professional life from medicine.

As we dive deeper to understand the concept and emergence of the portfolio physician, we have to make sure we understand the underlying architecture. The portfolio physician career is best thought of as an intentionally assembled set of complementary roles and assets that is unified by a single thesis and that has clinical work as its foundation. Similar to a financial portfolio, it has diversification, which provides resilience. It has layers that are intentionally added for asymmetric upside, and its structure allows compounding. The underlying assets that the portfolio physician career holds are analogous to the five forms of physician leverage discussed previously: knowledge, credibility, network, platform, and capital, which are modified into tangible working parts of the physician career.

Structural Considerations

It’s important to note that the portfolio physician isn’t simply a collection of different side hustles or side gigs. Side hustles tend to be added on, sometimes at random, and sometimes with the sole intention of adding income. Done in such a way, they can compete with clinical practice for the same scarce resource - time. The portfolio architecture, however, is integrated intentionally where each activity or role relates to, and can feed, the others. Importantly, this does not require leaving clinical medicine. Clinical practice remains the anchor and is not something that is trying to be replaced. The idea is expansion, not escape.

It’s not necessarily about ‘more’ or about ‘doing everything’ - some opportunities will be declined because they don’t fit into the coherent architecture. Collecting titles for its own sake could paradoxically harm the architecture. It doesn’t require perpetual reinvention and pivoting, or changing your identity every few years. Rather, it’s understanding that different layers and assets will compound over a long-term time horizon, and strategic moves help to build the portfolio career into a coherent architecture. Think evolution, not revolution. In this way, the career that you have built stays central and you don’t feel a false dichotomy of choosing between practicing pure clinical medicine versus abandoning medicine for something totally different.

The portfolio physician is someone who has built a deliberately assembled, thesis-driven set of holdings around a clinical anchor, not necessarily someone with a crowded calendar or an impressive LinkedIn.

Structural Forces, as opposed to a Personality Trait

There are a few reasons why the portfolio physician concept is emerging now. These reasons have to do with emerging market forces and underlying structural realities of the healthcare ecosystem, not just increasing ambition or curiosity on behalf of physicians. Conditions have changed since we started our training. For example, one big reality is that AI is restructuring the clinical day. Routine and mundane cognitive tasks are being compressed and the space that that leaves will be filled by new physician roles - some of which were discussed in the prior essay - including AI implementation, governance, monitoring, and so forth. The overall range of medicine is widening even as parts of it are being automated and eliminated.

Next, single-track economics are quietly deteriorating: reimbursements generally continue to decline, RVU expectations generally continue to increase, and consolidation continues to permeate the marketplace. All of these factors make the standard default single track career paradoxically riskier than it looks. Diversification and building intentional optionality no longer becomes the risky move, but rather one which de-risks the professional career.

Another reality is that your ability to impact other physicians, patients, and other members of the healthcare ecosystem is now more within your reach than ever. Distribution across multiple channels has become free to near free. This includes social media platforms such as LinkedIn, Substack, Facebook, YouTube, podcasts, and the like. These allow you to create a platform and spread your credibility much easier than you were able to a decade ago. You can collaborate with people across the country and across the globe. You can co-host conferences. You can work together in amplifying and spreading a message.

Another trend is that health tech and med tech needs more physician involvement, at all stages of their evolution. Expanding technological capabilities and the availability of capital have resulted in tremendous growth in these areas, particularly digital health, and this has resulted in real paid demand for physician founders, advisors, and board members. The market actively needs clinicians and pulls them into portfolio roles. Finally, related to the increasing availability of capital is that capital leverage is now available to individuals in a way that previously was reserved just for institutions. There are now startup investing syndicates, there are ways to have founder and advisor equity, and there are many different groups that provide physician-friendly investment opportunities. Your ability to be involved as a healthcare investor has never been easier than today.

So ultimately the portfolio physician isn’t a rebellion against the state of medicine today, it’s more a natural evolution of medicine’s underlying changing structure. As physicians, we should be aware of the multiple tailwinds that are blowing.

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Construction Mechanics

Let’s break down a little more tangibly how you would construct such a portfolio and what the underlying holdings are. The portfolio is more than a feeling or an aesthetic; it has underlying specific components, each of which connect to the different forms of leverage that the physician already possesses. Here are the four underlying components:

Clinical practice as the anchor. This remains the foundation, which informs the physician’s sense of meaning, purpose, identity, and respect, it also provides the core financial stability and makes the physician credible as they expand into the other components of the portfolio. This anchor is what is built on and is never a ceiling to escape.

Medicine can remain the foundation without becoming the entire architecture.

Intellectual assets - publications, writing, speaking, patents, IP. These are the ways in which you are known beyond the walls of your clinic. These are your knowledge and platform leverage components made visible more broadly.

Advisory holdings - consulting roles, leadership roles, board seats, advisory roles, industry involvement. These are the ways in which your credibility and network forms of leverage create an impact outside of the clinic. They also are ways in which you can create rewards for yourself that are uncorrelated to the direct exchange of time during your clinical work.

Equity holdings - founder shares, startup options or stock, angel investing, real estate investing. These are the ways you amplify the impact of your capital and start to create forms of financial leverage. You shift from exchanging time for money to owning assets that can either generate income for you semi-passively or that have the possibility for asymmetric upside.

What you’ll start to realize by looking at the above is that all of these map to one of the five forms of leverage that you already possess as a physician. The portfolio physician is the container that lets you hold all of these simultaneously and have them work together in a coherent, compounding, and amplifying way.

Conceptually, think of this model as a central planet with multiple orbiting satellites. The central planet is the stable clinical core and the satellites orbiting it are the complementary holdings. All of these are held together by the unifying single thesis. There are a few important characteristics of this model that make it robust and resilient at the same time:

Firstly, it has a central thesis, and isn’t a random accumulation of titles and activities. This central thesis is what turns the activities and roles into a portfolio as opposed to a collection of titles and activities. You may not know what this is at the outset, but after spending time in constructing the portfolio, you will eventually arrive upon it. It is the through line that makes all of the activities aligned and have the potential to impact each other and make the other components grow. For example, a radiologist’s thesis might be investing in imaging-related AI companies, or a dermatologist’s thesis might be helping patients understand truth from misconceptions about skin care in the public media.

A pile of projects is not the same as a portfolio.

Another aspect is that it is intentionally designed, not accumulated. All the roles make sense in light of the whole - if they don’t, they are declined, or they are trimmed or cut over time. The differentiator is the intentionality behind them.

Lastly, the underlying diversification of the portfolio occurs along three different axes at once. These axes are meaning (multiple sources of purpose within the construct of the career), diversification of income (multiple uncorrelated streams, some of which are active, some of which are passive/semi-passive), and there is diversification along the risk axis (no one activity represents a single point of failure). Wise physicians will diversify across all 3 of these axes.

What the Portfolio Looks Like in Practice

These are a few archetypes that emerge when the components mentioned previously combine around a central thesis - note that these are examples and not a comprehensive list:

• The clinical-AI translator: clinical practice plus AI evaluation, implementation, governance, and workflow

• The investor-advisor: clinical practice plus angel investing, startup advising, and board seats

• The physician-writer: clinical practice plus public writing, speaking, and a platform

• The institutional builder-intrapreneur: clinical practice plus leadership, operations, quality and safety, and care-model redesign

• The clinically diversified physician: clinical practice plus healthcare adjacent roles such as utilization review, telehealth, AI training, or expert-witness work

One note about the last archetype: some holdings, particularly the clinically adjacent ones, diversify your income and lower your risk more than they build compounding leverage. That’s still a valuable part of many portfolios - and along the three axes of meaning, income, and risk, not every holding has to hit all three. These all become a portfolio rather than a pile of projects because of the through-line running through them.

In an earlier essay, the physician leverage flywheel was discussed, and this flywheel is a big part of the reason that the components of the portfolio model work well together. For example, writing can create a platform, which then attracts advisory opportunities, which then in turn deepens and expands one’s network and can ultimately generate capital or access to capital. The capital then funds more building and creation, which ultimately creates more to write about. The longer the time-horizon for these activities to compound, the better it works - these activities begun in your 40s, for example, have 20 to 30 years to compound. Also, the compounding works best when these activities are synergistic, related, and additive - which is why having a clear through-line that ties them together has the best chance of amplifying the portfolio career as a whole. However, the earlier you are in this process, the harder it will feel. The first few turns of that flywheel are the hardest and require the greatest activation energy. But once the momentum has been built, the cascading effect is real. In my own case, these essays built a platform, which led to advisory conversations, which have expanded my network and access to additional opportunities.

The next steps to building out the portfolio career begin by assessing where you are today and keeping the clinical work at center. The portfolio is going to be built and scaffolded around this anchor. Next, see if you can write your thesis that’s going to tie your portfolio career together. When you have this, it will serve as a filter to decide what roles or opportunities will be layered on next, and what will be declined. It’s okay if you don’t have the thesis yet. You can make your best guess and start by adding one holding, not multiple holdings. Identify your first career experiment. This could be one essay that you’re pondering writing, one investment that you’re going to make, or one advisory conversation, and let it run its course before layering on the next holding. Avoid the instinct to build out all the layers at once, comparing yourself to someone who is years ahead of you. A fully built out layer is better than four half built layers. Also, keep your long-term perspective: think about the next 20 to 30 years as a design space instead of a fixed structure and path.

The portfolio physician has built a strategic, compounding, and resilient career, anchored by their clinical practice. The most interesting physician careers are designed, not inherited - one holding at a time, around an anchor you never let go of.

If you’re already building a portfolio without having a name for it, I’d like to hear what it holds. Comment and tell me your anchor, as well as the first new holding you’d add.

• Scott F. Cameron, MD is a practicing radiologist, AI implementation leader, angel investor, and MRS Past President. He writes about physician career architecture at Physician Vantage Studio.

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I remember reading the frantic press headlines from the media coverage of the Radiological Society of North America (RSNA) Conference in 2016. Everywhere, suddenly, the sky was falling. Famously, Geoffrey Hinton proclaimed that residency programs should stop training radiologists immediately because AI would be taking over. And he compared the radiologist to Wile E. Coyote standing at the edge of a cliff and not realizing that he was about to fall off.

A decade later, the reality is that not only are radiologists very much still an integral part of the patient care journey, but they are also in very high demand in the healthcare marketplace for a variety of reasons. Nevertheless, a lot of individuals believe that Geoffrey Hinton was directionally correct, and this notion of how AI will re-shape physician careers deserves serious attention as we see how dramatic the capabilities of these technologies have become. Having said that, this isn’t a doom narrative, and it isn’t a hype narrative either.

If you’re anything like me, anytime you’re at a cocktail party and let anyone know that you’re a physician - especially if you are a radiologist - there is a greater than 50% chance that the next statement out of their mouth will be, “So what do you think about AI?” What they usually mean is, “Do you think you’ll still have a job in the next five years?” But the more useful question - and the one I’ll focus on in this essay - is, “Given that AI is the single most consequential development of our professional careers, how can we position ourselves strategically to stay relevant and come out on top? How does AI change a physician’s value?” I believe that AI is the most powerful driving force that makes complacency about your career arc dangerous, and career design very valuable. AI can certainly be used as a tool and as an agent, but it is most powerful when wielded as career leverage.

At a high-level, let’s think about the application of AI into 3 levels:

Tool usage (prompts, ambient scribes, elevated search/research, general productivity, etc)

Workflow (triage, prior-authorization, communication loops, etc)

Career Architecture (new roles and optionality, acceleration of existing forms of leverage, and access to new levels of authority)

Level 3 is what this essay is about: how AI is creating novel physician roles, accelerating certain forms of leverage, and widening the gap between physicians intentionally designing their careers around it and those who have a watch and wait perspective.

Here’s what’s shifting right now. Firstly, AI technologies are becoming increasingly good at pattern recognition, across all domains of medicine. While imperfect, narrow use cases - such as detection of pulmonary nodules on CT scans, or patient triage, or prior authorization workflows - all of these are becoming faster, cheaper, and more seamless with AI. The gains are real, but they have been taking longer than expected and are still bounded by certain conditions that need to be true in real clinical environments. This doesn’t mean physician pattern recognition disappears, rather the value stack starts to skew towards the judgement, communication, and orchestration abilities of the physician. As this happens, the value of these human skills increases - there starts to be more of a premium placed on the ability to synthesize ambiguous data, to handle edge cases, and to communicate uncertainty to patients and other physicians.

Many AI discussions - particularly those in the C-suite - focus the conversation about AI around efficiency - more clinical work completed by fewer physicians, coupling AI with Advanced Practice Providers (APPs) to reduce the number of physicians on staff, and so on. These strategies are important value drivers, but for the purposes of this essay, I want to focus on something different.

As the human-specific elements of healthcare delivery move up the value chain and AI technologies mature in tandem, we will see an increasingly wide gap develop between physicians who use AI and are AI-literate, versus those who either don’t use AI or who interact with it very passively.

Given that, here’s a suggested way to think high-level about AI. Think of it as career leverage, and not just a clinical tool. The latter is something that is given to you to use in the workflow - whether you asked for it or not - almost like something done to you or done to your practice. The former is thinking about AI as an amplifying force for the five forms of physician leverage that you already have, discussed in a prior essay. AI isn’t a new form of leverage. It’s a force that accelerates the five you already have. Let’s look more closely at each one:

Knowledge leverage: Understanding how to use AI tools in a clinical context becomes a new form of knowledge, differentiating those who are AI fluent from those who are not. This form of physician who has the technical capabilities of using AI to drive outcomes or efficiencies becomes more rare and valuable.

Credibility leverage: Becoming an early, trusted voice on AI confers a form of differentiation and leverage because most clinicians are either silent or engage with AI from a position of cautiousness or fear, or they are too busy to engage with an AI in a meaningful way.

Network leverage: AI touches so many disciplines of healthcare and innovation that it creates a meaningful way for physicians to expand their network. They can be exposed to founders, engineers, scientists, writers, investors, and others, in ways that they may not have through a routine clinical career.

Platform leverage: Given that AI is one of the hottest and most in-demand topics, a physician who speaks or writes about AI can gain a meaningfully large audience. The demand for discussion and expertise on this topic may be higher than any other.

Capital leverage: AI familiarity and expertise can translate into advisory opportunities, investment opportunities, and other ownership roles in this rapidly expanding segment of the healthcare ecosystem.

Let’s contrast two physicians - one who is AI-reactive, and one who is AI-strategic.

The AI-reactive physician is fully intelligent and capable but views AI primarily as something that is happening to them. They wait to see what AI tools will be integrated into their workflow and then they start to learn how to use them. They think about AI primarily from the lens of disruption or efficiency and their default thinking tends to drift towards “how will AI affect my job?” They like to wait to see how AI will be adopted by others in the community and others in their specialty, and when the tool is unloaded into the workflow, they learn just enough about it to maintain competence in using it. From a career standpoint, it’s ‘something happening to them’, and in a five-year time horizon they are a competent physician who is able to use the tools in the marketplace, but they are essentially interchangeable with other physicians. Their leverage position is either the same or lower than what it was five years ago.

In contrast, the AI-positioned physician thinks about AI opportunistically, strategically, and from the perspective of something that is coming and will cause disruption, but that can be harnessed for positive gains for patients and the profession. This physician thinks about how they can best use AI tools and technologies in advancing the goals of their practice. They think about what opportunities that AI will create both in their institution and outside their institution - this is AI being used as material for new roles. They view AI as an exciting way that the career is being expanded. They look at AI education and fluency as a required investment into their future, and as a way to potentially differentiate themselves from the more AI-passive physicians. They don’t just learn the minimum required to use the tools, but they look at many tools across the marketplace, trends across the industry, and develop a point of view about where things are now, and where things are going. They look for roles that let them shape AI’s direction - in the rooms where these decisions are made - rather than just receive it. On a five year time horizon, they become a respected public voice that has greater career optionality and leverage. They experience the compounding effects of knowledge, network, and platform.

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AI has already created new roles adjacent to clinical work. Here are a few practical examples which are emerging at the intersection of medicine and AI. Not every physician should pursue these, and also we should keep in mind that they can co-exist with active clinical practice. They are listed as examples to make the opportunity more specific and concrete:

The implementation leader guides AI evaluation and adoption inside a practice or healthcare system - understanding not just the technology but the clinical use cases, the true clinical workflow, trust dynamics and buy-in, and how clinicians actually behave when new tools hit production.

The clinical-tech translator helps engineers, data scientists, founders, and physicians understand each other. Clinical expertise informs product and process requirements that developers don’t necessarily possess on their own.

The model evaluator assesses AI tools from a clinician’s perspective - performance, safety, usability, brittleness, real-world reliability, data bias and drift - helping bridge the gap between a promising demo and successful real-world deployment.

The governance and safety voice participates in oversight, policy, and risk evaluation for responsible AI deployment. This is the physician or clinical champion who makes sure that the humans stay in the loop.

And the educator and sense-maker teaches other physicians how to think about AI without resorting to tips, fear, or hype - a role that is increasingly needed and more underserved than most others right now.

Again, none of these require abandoning clinical work wholesale or joining a startup. For most physicians these start with one decision and one action.

In my own professional work, I’ve walked down some of this road. Having been interested in AI for many years, particularly in the specialty of radiology, which lends itself very well to many AI applications, I started to learn early on about different AI companies and the tools they were developing. This included companies like RadAI (in which I later became an investor, disclosed below), developing tools to streamline radiologist reporting and closing patient communication gaps, and Prenuvo, developing whole-body MRI screening technology. This led me to being more deliberate about my AI education, and I completed the Radiological Society of North America (RSNA) Imaging AI Certificate Program. This course taught me how to assess and confidently use AI tools, and the different parts in the development of AI algorithms. After the course I felt more comfortable in knowing how to safely evaluate, deploy, and monitor AI tools in my practice. This doesn’t mean I became an AI expert, rather, it gave me the baseline knowledge where I felt comfortable being in the rooms where discussions about AI are had. In my practice - and in many others out there - that is relatively rare.

This then informed the evaluation, selection, and usage of some software we then used in our practice, such as Koios AI for thyroid nodule detection. Today, I sit on the Optum AI Advisory Board, where we critically evaluate emerging AI technologies and platforms and their potential benefit across multiple Care Delivery Organizations in our network. In this capacity, I see where there’s hype and where there’s reality - the potential gap between the demo and the deployment. This is practical, real-world knowledge that makes a difference in how healthcare is delivered.

Along the way I also started to learn - through my network - about opportunities to participate in AI imaging trials. These studies helped commercial vendors creating AI algorithms for radiology applications understand how the software would work in radiology applications. Through these trials, supporting companies such as ContextFlow, Aidence, and IBM Watson Health, I participated as a reader and helped evaluate new artificial intelligence software algorithms in the diagnosis and characterization of lung nodules on chest CT scans, the detection and diagnosis of liver disease, and other applications.

At around the same time I also became involved in AI as it touches the investing domain - I became a clinical advisory board member for AngelMD, as well as a member and investor of Launchpad Venture Group. Through these activities I joined a group of early-stage startup investors in evaluating rapid-growth startups that were aimed at creating innovations in healthcare (as well as non-healthcare sectors), many of whom were using AI - one such company that came across my radar was the aforementioned RadAI. Through evaluating these startups, I get a glimpse into the problems these founders are trying to solve, and the physician-centric elements that they can’t replicate.

This isn’t to say that you need to do all of these things in order to parlay your interest in AI into larger opportunities - the point is the orientation around how to approach AI and how to participate in ways above and beyond simply using AI technologies once they are integrated into your practice - and wondering ‘What’s going to happen to me?’

The certificate I earned started with one course.

The investing started with curiosity.

The advising started with one conversation.

Each led to the other.

Ultimately, AI is here and is accelerating change in all industries - with healthcare being no exception - but the real frame here is AI as career leverage. There are real challenges, questions, and limitations around how these technologies will be able to be used in clinical workflows. The time to engage with it and be proactive is here, and it’s available to any physician, regardless of specialty, background, or skillset. It’s possible to engage in a way that matches your interests and aptitude and fits within the context of who you are professionally and how you practice - every specialty has it’s AI-adjacent frontier. This isn’t a call to become a data scientist, an engineer, or a machine learning expert. After all, as discussed previously, it’s the human judgement, coordination, and communication layered on top of the AI-augmented intelligence that will drive value. This physician-anchor remains foundational as you build AI-fluency across your career - and remember that this shouldn’t be viewed necessarily as a new task, but rather a new lens that makes your work more leveraged.

For a next step, think about where it is in your clinical practice that you already have specific credibility? What AI-adjacent clinical problem do you understand better than most of your colleagues - and what role could you test out, in a small way, in the next 90 days?

If pure diagnostic ability and pattern recognition starts to decline in value, then the physician who builds beyond that - by developing their integration, communication, AI-fluency skills, and different forms of leverage - will start to become the de facto ideally positioned physician. This means that the natural form of the physician role won’t be the conventional standard ‘one job, one role’ but rather a portfolio. There’s a name for the type of career that fits this moment in time, that is crafted with multiple deliberate layers rather than in a single track. I’ll be writing about that next.

Where are you in your AI journey currently? Thinking, exploring, using, building, worrying…? Using AI as a clinical tool in your practice, or as something that you’re actively building with, as leverage? Let me know in the comments.

Disclosure: I hold investment positions in and advise healthcare AI companies, including RadAI and through Launchpad Venture Group and AngelMD. I also participate in AI evaluation work in my clinical role. The views here are my own, are not intended as an endorsement of any specific company, and are not those of my employer or any affiliated organization.

• Scott F. Cameron, MD is a practicing radiologist, AI implementation leader, angel investor, and MRS Past President. He writes about physician career architecture at Physician Vantage Studio.

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What does a physician in their 40s feel after a busy but ordinary workday?

How often have you found yourself during a busy day in the clinic checking the clock repeatedly, not just to make sure you’re on time with your patient appointment slots, but also just to see how much of the day has elapsed? You peek at the clock icon in the lower right hand corner of your computer screen - 2 p.m. - and the thought pops into your mind before you can suppress it: I still have a handful of hours left to go … how many more of these days can I string together? What’s going to break up this routine? Although there are some spikes of satisfaction and meaning during the workday and the workweek, you can’t shake the question that surfaces from time to time:

Is this going to be the repeated pattern for the next 10, 15 or 20 years? And then you allow yourself to be distracted from that thought by the patient that is in front of you that requires your attention and expertise.

Those thoughts - the ones you quiet and suppress before they fully form - is where this essay begins. There is an increasingly common regret that many physicians have as they enter their 40s. It isn’t a regret about being a physician or the impact they have on patients. Rather, it’s a regret about how little of themselves they were able to put into their career.

Let’s break down a little more about what this regret is and what it isn’t.

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What the regret is NOT about:

The regret is not about being a doctor. It’s not about burnout. It’s not about being ungrateful for your position and all the benefits that you have. It’s not a desire to have gone down a different professional path.

What the regret IS about:

The regret isn’t about medicine; it is about what traditional medical practice crowded out.

The regret is about realizing that you could have expressed yourself professionally in different ways; you could have explored different opportunities and run different experiments, but for different reasons, you chose not to. It’s the sense that your career is somehow narrower than your capabilities, skills, and interests should really allow.

You didn’t cultivate external relationships that you could have, you could have taken more risks, you could have made your skills and expertise more visible to the broader world.

That version of your professional self - the one that represents who you really are - never fully manifested because the default physician career script didn’t allow it room to grow.

WHY THE 40s?

Interestingly, the 40s tends to surface this feeling because it stands at the crux of several converging factors. The first is that your natural career arc can potentially plateau at this point. You are past the initial training phase, and generally you have integrated yourself into your practice, potentially having formed partnership or some leadership roles. There’s a sense of some stability for how you practice and your place in the practice. And as these things are complete, the novelty and the ascension has worn off and the horizon for the remaining years becomes more visible.

Time becomes more palpable. In your 30s, your career feels wide open. In your 40s, you can actually start to project out the latter third of your career in your mind. You also tend to have some more bandwidth as some of the demands of training in early practice have dissipated. And with that increased bandwidth you can reflect on where you are, where you’ve come, and where you’re going.

When you’re in your 40s, your peers start to demonstrate their career trajectory. You’ll see concrete examples of what other people are capable of and you start to think about the different versions of yourself that were possible. This sharpens the question of why you didn’t pursue some of those same paths. Could you have done that too? Should you have taken that risk, that step?

Turning 40 is also a meaningful milestone for anyone, physician or not. It’s a concrete reminder that time is finite, that you’re getting older. Around this time you may have had a significant event happen to a family member or someone you’re close to - perhaps the loss of a parent, or an unexpected illness befalls someone close to you, or the ending of a close relationship. All of these things make you pause and introspect - and how you spend the majority of your time - your career - will definitely fall under the microscope.

Yet, your 40s are still a time period in which you have agency to design a significant portion of your remaining career. You still have a decent amount of runway and this potential regret arrives at a time when it can still be acted on. In a positive way, it serves as an early warning sign rather than a final verdict.

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WHY THIS REGRET CAN STAY HIDDEN

This regret, however, can stay silently below the surface, and this repression makes its effects worse. Firstly, regret can appear to some as ingratitude. It’s reflexive for some to think, “why does this physician who has so many good things going for him feel any sort of regret whatsoever? Who’s this person to complain; what right do they have?” So physicians tend to stay quiet to avoid seeming unappreciative.

Additionally, this sentiment is hardly ever voiced by other physicians, and when you don’t see anyone else around you talking about this, and your peers appear either content - or have a sense of resigned acceptance - then the silence becomes self-reinforcing. Each physician might assume that they’re the only one that feels this way, and think ‘other doctors seem fine’. They’re not. This is one of the most common experiences in mid-career, and one of the ones least vocalized. The silence around it is not evidence of absence.

We’re also trained to endure situations and not to necessarily push back against them or question them. Medicine requires a degree of sacrifice and stoicism, and questioning the arc of your career can feel like a weakness, a chink in the armor that you don’t want to expose.

Finally, there isn’t a specific language for this feeling. And without that precise language and definition, it becomes more of a vague sense of unease and restlessness that you experience at 2 p.m. in the clinic. And if it’s not concrete and nameable, it’s hard to fix it. Part of what this essay series hopes to do is to actually name that feeling - because unnamed things are hard to address, and this one deserves to be acted on.

The positive aspect of this is that regret experienced early enough becomes data. It becomes information, a compass. It points you in the direction of where you should go and what the next layer of your career should include.

Regret surfaces your values because you only regret things that you legitimately care about.

It nudges you to unearth your values and bring out those pieces of you that you’ve left unexpressed.

Also, regret about the future is still editable. The better question to ask yourself is not, what do I regret about the choices I made in the past, but rather, what will I regret at age 65 if I don’t make the changes that I’m thinking about now? That second regret hasn’t occurred yet and is within your control. Again, the 40s are a decent starting line and there is still a large enough time horizon for a physician to create something significant. So this regret, if acted upon early, serves as a launching pad for bigger things to come for the physician’s career.

WHAT TO DO WITH THIS SIGNAL

The first thing is an honest acknowledgement that an element of this regret exists, and to name it for what it is. This brings it out in the open and removes some of its power and control over your trajectory.

The second is to understand that regret serves as a map and a compass that will guide you. Ask yourself what specifically has gone unexpressed in your professional life up to this point in time: is it the part of you that could be the builder, the part that could be the innovator, the writer, the investor, the leader … these answers will guide you towards where to begin.

Next, take this signal and let it nudge you towards one small step. Start with one small bounded experiment or action that begins expressing the unexpressed part of you. Maybe this is exploring AI leadership, maybe it’s interviewing 3 people, maybe it’s joining a cross-institutional collaborative project. Maybe it’s mapping opportunities or assets. Finally, appreciate that this signal indicates that the next 10, 20, or 30 years do not have to be a static continuation of the path that you’re currently on. Those years are unwritten - a design space, with you as the physician architect.

Keep in mind that most physicians spend their 40s suppressing this feeling, but the ones who truly listen to it design a different next 20 years.

The physicians I’ve observed who are least burdened by this regret in their 50s and 60s tend to have one thing in common: at some point in their 40s, they made a deliberate choice to design their career rather than inherit it. They don’t mistake stability for design. And they realize that they don’t have to blow up their career with a big leap - a small, deliberate, judicious experiment is enough to start. In the next essay, I want to give that choice a name - and show you what it looks like in practice.

If this names something you’ve felt before but haven’t vocalized out loud, I’d love to hear from you. You’re not the only one. Comment and tell me what part resonated.

- Scott F. Cameron, MD. Radiologist. AI implementation leader. Angel investor. MRS Past President. Career architect.

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What would you say if I told you that your most valuable professional assets aren’t your clinical skills, aren’t listed as line items on your CV, and weren’t taught to you in medical school or residency?

Your most valuable assets are your different forms of leverage.

There are five discrete forms. You may not be aware that they exist or be aware of how to activate them. But before we dive in, let’s first define what leverage is and what leverage isn’t.

Leverage is the ability to amplify your output per unit of input. It’s about getting disproportionate results - whether in income, impact, or opportunity - with the same level of effort. When you’re activating leverage, it compounds over time and accumulates even when you’re not actively working.

It’s important to contrast this with what leverage is not. Leverage does not mean increasing linear inputs such as hours spent at work, RVUs, or productivity. That model is not sustainable from an energetic perspective, and is also fragile in the age of increasing pressures from AI, reimbursement challenges, and consolidation. Physicians that have intentionally activated different forms of leverage will be hedged against some of these pressures.

THE FIVE FORMS

Form 1 - Knowledge Leverage

Using your clinical knowledge and expertise to create value outside of the clinical setting - expertise that extends beyond the clinical encounter.

Examples: My participation in the AI Advisory Board at Atrius/Optum, where I help evaluate AI software and platforms for integration into our practice. Quality and Safety Workshop creation in tandem with the insurer Coverys, to help practices across the country learn how to better manage incidental findings discovered on imaging exams.

Form 2 - Credibility Leverage

Using your physician credential itself to open doors, access opportunities, and create trust above and beyond the clinical setting.

Examples: Advocating for healthcare reform in Washington DC alongside hundreds of other physicians wearing their white coats in the halls of Congress. The MD credential signaling trust, status, and judgement in conversations with healthcare founders and investors.

Form 3 - Network Leverage

Utilizing relationships built over time through either your practice, professional societies, or your training to create access to opportunities, people, ideas, and introductions.

Examples: 15+ years of relationships in professional societies, such as The Massachusetts Radiological Society, and the American College of Radiology, leading to leadership opportunities in both organizations. Deep investor networks built through my time spent with the Launchpad Venture Group, AngelMD, and various other physician investor circles, leading to investment opportunities such as in the Series A investment round for RadAI. Gaining an invitation to speak at a national conference (RSNA) through reaching out to a fellow physician that I know through my network.

Form 4 - Platform Leverage

Using your public presence - whether through your social media channels, your reputation in your specialty or across the conference circuit, or through your writing or a newsletter - to amplify your visibility and transform it into opportunity.

Examples: MRS and RSNA conference speaking. Physician Vantage Studio creating opportunities for collaboration and discovery, such as a guest-podcast invitation I received recently to be interviewed on the Let Care Speak podcast. LinkedIn presence now approaching 1000+ followers and growing.

Form 5 - Capital Leverage

Using financial resources to create investment positioning, ownership interests, and business interests that create returns either disproportionate to - or independent of - hours worked.

Examples: Equity shares in multiple healthcare startup investments, some of which are positioned very well (and some of which have not been successful), and real estate investments. Using financial stability to buy back time which is then invested in other ventures, such as building Physician Vantage Studio. This could also include ownership of medical office space, or equity in clinical practice ownership or ASC ownership.

HOW THE FIVE FORMS COMPOUND

The important thing to understand is that these five forms of leverage are not independent of each other, but rather work together as a flywheel. Each part of the flywheel amplifies the effect of the others.

The flywheel works like this:

The Physician Leverage Flywheel: Knowledge creates Credibility. Credibility expands Network. Network expands Platform. Platform generates Capital. Capital funds the next investment or experiment. Each rotation of the flywheel is stronger and faster than the one that preceded it.

Knowledge opens the door for you and credibility makes you trusted once you’re there.

The network amplifies as your work permeates and compounds, which leads to a platform that magnifies your visibility.

Then capital follows as the flywheel turns.

Let’s run through a specific example from my life. My radiology expertise (Knowledge) combined with my AI interests and expertise (such as those gained through my RSNA AI certificate) gave me credibility as an AI implementation leader in my practice (Credibility) which connected me to other physician leaders and AI experts through my participation in my practice’s AI advisory board (Network). This informs my writing through LinkedIn, Substack, and Physician Vantage Studio, which then surfaces investment or collaboration opportunities (Capital) through outreach from investors and innovators I connect with in-person and online.

Once again it’s important to note how these forms compound. Each form of leverage makes the others easier to activate.

So, a physician with a rich network and platform leverage tends to learn about advisory opportunities (that they may not have discovered otherwise)… which can then be executed with knowledge leverage. These forms of leverage end up multiplying each other instead of being additive.

The gap between having leverage and using it is mostly a matter of awareness.

Here’s the honest baseline analysis for where most physicians stand across all five forms:

Knowledge Leverage: Already formed and available, but generally underutilized outside of the clinical domain.

Credibility leverage: Already intrinsically there by definition, but generally underutilized in the non-clinical context.

Network leverage: Partially formed, strongest within medicine and typically within one’s specialty, but weaker outside of it. Large potential to be amplified and grown over time through intentional strategic relationship building in adjacent contexts.

Platform leverage: Generally underdeveloped. Most physicians have a relatively minimal public presence. This leverage form can generate a strong return on investment because it compounds over a long time horizon.

Capital leverage: Depends on the state of the other four, and most physicians don’t activate this until forms 1 through 4 have been activated to a certain degree.

So the good news is that as a physician you have at least three of these five forms of leverage available to you right now, although you may have never activated them fully. The five categories of opportunity listed in the prior essay are the destinations, and these five forms of leverage are the ways to get there.

In the next essay, I’ll dive into the specific regret that builds when physicians reach their 40s with leverage they never activated - and why that regret tends to be more common, and more preventable, than most physicians realize.

Which of the five forms of leverage do you feel is strongest for you, which is dormant, and which one do you think you could change the most in the next five years? Comment and let me know.

Disclosure: I hold investment positions in healthcare companies including through Launchpad Venture Group. Views expressed are my own and not those of my employer or affiliated organizations.

• Scott F. Cameron, MD is a practicing radiologist, AI implementation leader, angel investor, and MRS Past President. He writes about physician career architecture at Physician Vantage Studio.

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I remember the first time I heard one of my colleagues talk about her role as an advisor to a healthcare AI company - RadAI.

We were chatting informally at one of our state medical society meetings, and she mentioned almost in passing that she spent a half day per week helping the company build out their technology. She was integrally involved in product development, working alongside engineers, marketers, project managers, and other physicians. She was excited, energized, and clearly in on something at the ground floor.

I thought, “how did she even know that was an option"?

At the time, I also had the opportunity to become an advisor to that company, but I declined - I told myself I didn’t have the time. Looking back, I remember this as one of the formative moments where I first understood that there were paths available to physicians that simply weren’t visible from inside the normal clinical day. This, and other experiences since, has led me to one of my central observations:

Physicians don’t have an opportunity problem. They have an opportunity visibility problem. That distinction matters - because the first is hard to fix, while the second can be addressed today.

WHY THESE OPPORTUNITIES ARE INVISIBLE

This visibility problem exists for a handful of reasons, most of them structural realities of modern medicine.

First, medicine is fairly insular. Many physicians work within a relatively closed ecosystem. If you work day to day alongside similar physicians doing similar things, you aren’t naturally exposed to other ideas and possibilities. Even across different institutions, the day-to-day experience of physicians can be remarkably similar.

Second, role models can be hard to come by. If you don’t happen to have someone around you who has constructed an interesting or atypical professional career, you won’t be exposed to that type of person - or to who you yourself could become. My chance encounter with my colleague advising a healthcare startup is one example of this. If you happen to be introduced to someone who created a healthcare startup incubator, for example, you realize this path is possible. Without that role model, you simply wouldn’t know it existed.

Third, medical training doesn’t introduce us to these adjacent possibilities. It’s focused on teaching the foundations of medicine - physiology, clinical practice, and direct patient care. Advisory work, innovation, advocacy, leadership, and platform building don’t appear in most curricula, although some institutions are beginning to layer in a few of these elements.

Fourth, these healthcare-adjacent opportunities tend to be quietly active. There are many opportunities available to physicians at healthcare companies, conferences, and venture capital firms. But these worlds generally exist in parallel to clinical practice rather than being integrated with it. Our day-to-day clinical work rarely collides with these adjacent worlds.

Fifth, the default physician career script plays a role. When you’re in the middle of your professional career, no one is necessarily going to stop you along the way and say, “Maybe you should look into X, Y, or Z.” You simply continue moving down the professional path you’re already on.

The opportunities exist. The problem is an absence of visibility and awareness. The landscape is there - it’s just that the line of sight is obstructed. In Essay #2, I called this Opportunity Blindness - one of the four structural drivers of the Physician Optionality Problem. Here is what it actually looks like on the ground.

THE EVER-EXPANDING LANDSCAPE

The good news is that these adjacent opportunities are growing, and there are more of them than ever before. Several forces are driving this expansion.

One major force is the AI revolution, which is creating entirely new roles for physicians. Healthcare AI companies are actively seeking physician advisors, and health systems want physicians who can architect care delivery models and evaluate, implement, and monitor AI software tools. AI implementation leadership is becoming a growing category of role that didn’t exist five years ago.

Healthcare innovation continues to accelerate as well. There is more capital flowing into healthcare - especially as interest rates have declined relative to recent years - and more demand for physicians to be involved at every stage of product development, from idea validation to board advisory.

Significant institutional changes are also shifting the landscape. As health systems restructure and consolidate, they adopt new technology and rethink their infrastructure. The physicians who position themselves in AI leadership and internal innovation roles are creating specific career opportunities that didn’t exist a decade ago.

Lastly, public platforms have democratized the ability for physicians to make an impact and have lowered the barrier to influence. Writing on LinkedIn, publishing on Substack, and speaking at conferences - whether in person or online - are available to any physician willing to show up consistently. Platform leverage was once reserved for those with established media power. It is now available to anyone with an electronic device and a commitment to publishing.

The takeaway: even if you’ve felt stuck for years, the opportunities around you have been expanding the entire time. The opportunities in front of you today are not the same ones that existed when you started your training.

THE FIVE CATEGORIES OF OPPORTUNITY

Here are five categories of opportunity where physicians can have an impact, starting with the lowest barriers to entry and scaling toward the more ambitious.

1. Within Your Institution

Sometimes called intrapreneurship, this is the most accessible category. Examples include AI implementation leadership - I’ve done this myself through my institution’s AI Advisory Board, where I evaluate AI software technologies (such as software detecting and evaluating thyroid nodules seen by ultrasound), interface with vendors and IT personnel, and play an active role in shaping the future of our radiology tech-stack. Another example is quality improvement projects with meaningful impact. I once created an e-consults program for our radiology department, where we provided reinterpretation of outside imaging studies to help ordering providers answer specific clinical questions - with the goal of eliminating unnecessary downstream imaging. This initiative was widely successful and is a model that could be extended across a larger practice ecosystem. Any negotiated, protected time tied to value creation also falls into this category.

2. Adjacent to Clinical Practice

An example would be medical advocacy and leadership in professional organizations. I’ve been involved for many years in the Massachusetts Radiological Society, having served as past president, where I played an active role in shaping policy around payment models, AI governance, scope of practice, and patient insurance coverage. I’ve also been involved in creating CME-accredited curricula for quality and safety initiatives - including a multi-part webinar series developed in partnership with the insurer Coverys, focused on the management of incidental findings seen on advanced imaging. Another example is structured innovation education, such as the MESH Healthcare Innovation Bootcamp at Mass General Brigham, which I completed and which helped build my foundational literacy in medical innovation.

3. The Healthcare Ecosystem

This category includes advisory roles for healthcare startups - such as my prior advisory work with Quantively, a company that helps optimize MRI scanner utilization - and investing in healthcare startups through angel groups. I’ve invested in several early-stage companies through Launchpad Venture Group, where we collectively evaluated and invested in promising healthcare ventures. These roles depend more heavily on external networking but can pay off disproportionately in terms of knowledge, relationships, and financial return.

4. Public Platform

This includes speaking at conferences - I’ve presented at national meetings such as the Radiological Society of North America - as well as creating conferences, such as a new conference I created and moderated on behalf of the Massachusetts Radiological Society, where we partnered with the Massachusetts Radiology Business Management Association. This can also include teaching online, creating CME courses, and writing publicly - such as what I’m doing here at Physician Vantage Studio. These platforms are available to any physician who is willing to publish consistently.

5. Entrepreneurial

This is the most ambitious category, and includes building a physician-led practice with a new model, co-founding a healthcare startup, creating a new service or product, or taking an interesting role in industry. It exists, it is accessible, and many physicians have chosen to follow this path.

What I’d like you to notice across all five categories is that none of them require you to leave medicine. They all build upon your foundation as a physician and leverage the clinical expertise you’ve developed over the years. And they all start from exactly where you are today.

WHAT THIS ISN’T

I can anticipate some reflexive objections, and I want to address them directly.

First, I’m not advocating that anyone take on a role that adds significant hours to an already packed schedule. It doesn’t make sense to layer on a 10 to 20 hour per week commitment when you’re already working 40-plus hours. Career architecture is about awareness and strategic reallocation of time - not adding to your already busy workload. Most physicians who layer on these opportunities do so by strategically replacing lower-value activities - committee work they don’t care about, charting they could batch more efficiently - with higher-value ones. The total number of hours doesn’t go up. The composition changes.

Second, this is not an all-in entrepreneurship strategy where you push all your poker chips to the center of the table. Categories one and two are fully available to physicians with no entrepreneurial aspirations whatsoever. Most readers will find their most natural alignment in institutional and adjacent roles - not in startups.

Third, this is not about abandoning medicine. Every category keeps clinical practice as the anchor. The point is to add layers - not to replace the foundation. Evolution, not revolution. Opportunity expansion is about doing things differently, more intentionally, and with a wider line of sight.

In the next essay, I’ll walk through the Five Forms of Physician Leverage - the specific tools that make accessing these opportunities not just possible, but increasingly inevitable.

Which of the five categories surprised you most, or resonated most with your situation? Which one feels like the most natural starting point right now? Comment or message and let me know. I’m building this conversation with the physicians who recognize themselves in it.

• Scott F. Cameron, MD is a practicing radiologist, AI implementation leader, angel investor, and MRS Past President. He writes about physician career architecture at Physician Vantage Studio.

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You’re at a family gathering and before you know it, one of your parents wants to introduce you to someone who’s there that you haven’t met before. You know exactly what they’re going to say before they say it – “This is my son - he’s a doctor.” As they beam with pride, you realize that there’s really no other way that they would have introduced you. And it’s probably the most common way that you would introduce yourself to someone at a dinner party, or when you’re seated next to a stranger on a plane. It’s become such a core part of your identity that you’ve said it a thousand times before without thinking.

As it turns out, your physician identity is the most successful identity that you’ve ever created. It’s also the most expensive.

There are several forces that combine to create the Physician Identity Trap, which is actually one of the more deeply formed identities compared to almost any other profession:

Duration: Over a decade of training and apprenticeship take place before practicing independently. Very few professional identities take this long to forge.

Sacrifice: All the things that you delayed or gave up along your journey. Relationships, opportunities to socialize, years when you could have been earning, sacrificed sleep, and lack of geographic flexibility.

Meaning: What you do is deeply important and meaningful. It is a calling. You help people at their most vulnerable. Identity built on meaning is stronger than identity built on status.

External Validation: Societal rituals enforce the identity. Graduations, white coat ceremonies, the moments your parents introduce you as “the doctor”.

Community: Your collaborators and colleagues, the peers that have been in the trenches with you, and your social network, all of these reinforce the identity that being a physician is who you are.

This identity is truly a gift in many ways. It gives you a clear sense of purpose and meaning. It gives you direction and fortitude during the hard moments of your practice. It gives you a strong sense of respect in society. It gives you a sense of satisfaction for the skills and knowledge that you’ve earned over many years. And it gives you a clear sense of who you are as a person and as a professional. For many of us, it’s the clearest sense of the self that we’ve ever had.

However, the physician identity trap has its costs. You can have difficulty imagining yourself as anything else, or embracing any role that is outside of the predefined concept. You can cling to it tightly because of all of the aforementioned benefits. Ironically, the very same identity that served you and propelled you during your first 15 years of practice can artificially constrain you for the next 15.

Here’s how this identity trap can manifest:

The identity confirming choice:

Every spare moment somehow gets assigned a medically related task to do. There’s always a patient chart that you could be completing, a medical article that you could be reading, or a PowerPoint presentation you could be updating. You even do this on your days off, evenings, or weekends because that’s what a committed physician does. The identity is hungry, ambitious, and competitive, and will consume your choices and free time. This can also manifest in the physician who accumulates titles, institutional roles, and committee memberships not out of genuine interest, but rather because they confirm the physician identity and ascension up an identity ladder.

The “I’m just a doctor” excuse:

If you’re asked about your views on any subjects that are not directly related to what you do, such as policy, business, AI, or finances, you think, or say out loud, ‘I’m just a doctor’. This disclaimer keeps you safely inside the role.

The pre-emptive rejection:

If someone at a conference mentions to you about a new opportunity such as startup advising or consulting for a healthcare company or writing publicly, you instinctively reject that, thinking to yourself, ‘this isn’t what a physician does’. This dismissal can happen in a few seconds before there is even any genuine consideration.

The frozen mid-career physician:

You have this nagging sense that something more could be out there, but you feel scared about how to start, or feel like it could in some ways be a threat to who you are. So there’s this weird middle ground between persisting in what you’re doing and stagnating, versus jumping onto a different path and losing your identity. Neither option feels quite right.

The pre-retirement panic:

Some physicians’ identities are so deeply tied to being a physician, that the thought of retiring is almost tantamount to losing a large sense of one’s identity. If you’re not a practicing doctor anymore, who are you?

We need to think about the costs of maintaining a rigid professional identity. One cost is lost possibilities - avenues that could have been pursued but that didn’t necessarily neatly fit the physician role get rejected without proper evaluation and consideration. 15 to 20 years of foreclosed opportunities create a much narrower and less interesting professional life than what the physician’s capabilities could have actually allowed. Second, there is identity fragility. If your sense of self is built on one role, anything that threatens that role can feel existential. For example, AI changing radiology workflows feels like a large threat rather than a tactical adjustment. Lastly, there’s this nagging thought that there are unlived versions of yourself. Who could you have been as a builder, as a consultant, as a strategist, as an investor, as a writer, as a founder? These versions of you are possible and exist as untapped

potential but they can get no energy put towards them because of the physician identity trap.

The beautiful structure that you have built around yourself was built brick by brick, year by year, but you don’t see how it confines you, you see it as who you are.

We need to understand, however, that there is a path forward that preserves your identity as a physician but expands upon it instead of replacing it. It’s adding layers to your foundation as a physician. It treats your position as a physician - which is a source of purpose, competence, and pride - as the anchor and not the ceiling, and other identities are built alongside it. Understanding that identity can be architected rather than just inherited, we can trace its evolution through four phases.

The Identity Expansion Model:

Phase 1 - Fused Identity: “I’m a doctor.” The physician and the person are strongly fused, and being a physician is inseparable from one’s sense of self. Many physicians can occupy this phase for years if not decades.

Phase 2 - Permission: I’m a doctor who also happens to be curious about other possibilities. The window to explore different avenues has opened and you start to peek through it.

Phase 3 - Integration: I’m a doctor who also happens to be an advisor, a consultant, a writer, a speaker, or an inventor. You become a physician who has embraced multiple identities and roles. You become a multi-hyphenate and the self becomes plural.

Phase 4 - Architecture: I’ve intentionally designed a career and life that complement each other and are bespoke to me, with my clinical work laying the foundation for the other things I do. Identity becomes something you consciously craft and architect rather than something that you passively propagate through time.

Adding identity layers doesn’t diminish the physician identity. It actually expands upon what the physician identity means and what it can hold, rather than replacing it. The radiologist who also serves as an AI advisor is not a lesser radiologist. She is a radiologist whose identity has expanded to include something more. The internist who advises a healthcare startup is not less of a physician - she is a physician whose clinical experience is now shaping products that even reach patients she will never meet in the clinic.

Ultimately, identity is not something you have, it’s something that you intentionally create and architect.

In the next essay, we’ll dive into the Five Forms of Physician Leverage. These are the tools that underpin identity expansion. This is because expansion is by necessity strategic and not just a psychological reframe.

If this essay resonates with you, let me know which of the trap manifestations hit hardest - the “I’m just a doctor” deflection, the pre-emptive rejection, or something else? Let me know. I’m building this conversation with the physicians who recognize themselves in it.

- Scott F. Cameron, MD

Radiologist. AI implementation leader. Angel investor. MRS Past President. Career architect.

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I remember one quiet morning walking into my office and cleaning off my keyboard, turning on my monitors and the lamp behind them, and sitting down and staring at an incredibly long list of imaging cases for me to read. I realized in that moment that this was deja-vu all over again from last Tuesday and the Tuesday before that. I understood that I was essentially executing the same plan over and over again, with no real reflection on where it was ultimately going. I was essentially doing my job - and I felt a sense of predictability, not possibility. Most physicians have never written a career plan. Rather, they have followed a path, but a path is not the same thing as a plan. I had been executing someone else’s design of a career. And the more I looked around, the more I realized almost every physician I knew was doing the same thing.

I was executing a default physician career script. I was living in it.

Here’s how I break down the Default Physician Career Script:

• Stage 1: Pre-med: Make sure you have the highest grades possible. Volunteer in a hospital or health clinic if possible. Shadow a physician. Perform well on your MCATs. Ultimately decide you want to go into medicine by your late teens or early 20s before you have any significant meaningful exposure to medical practice.

• Stage 2: Medical School: Intense focus on didactic courses and dedication to core clerkships. Decide on a specialty based on perceived interest, lifestyle, prestige, salary, or the random influence of one or two friendly or charismatic attendings.

• Stage 3: Residency: 50 to 80 hour work weeks. Overnight shifts. Submission to hierarchy. Making a fellowship decision based on the fact that “everyone successful in this specialty does a fellowship”.

• Stage 4: First Attending Job: Choices made based on geography, where a partner works, proximity to family members, or whichever practice made the first reasonable offer.

• Stage 5: Mid-career: Productivity expectations, RVU metrics, committee responsibilities, slow accumulation of administrative burden, the same Tuesday in clinic year after year. Seeking titles, partnership, leadership.

• Stage 6: Pre-retirement: Decrease hours to part-time. Mentor the next generation of physicians. Retire. The end of the default career script.

At no point in the path does someone necessarily stop you to ask, is this what you actually want?

This script isn’t necessarily a bad thing, or even bad intentioned. It’s created by structural forces that individually make sense and to keep you progressing along the path.

This script gives physicians a clear path, external validation, stable income, a sense of professional and social respect and identity, and deep clinical expertise. However, the script doesn’t necessarily give you insight into how to design a second professional arc, how to utilize leverage beyond your clinical productivity, how to negotiate or create roles, how to assess optionality, or how to choose a path when no one guides you towards the next step.

It’s easy for physicians to stay on this path because from the very outset we know that medicine attracts and awards individuals that are excellent at executing well-defined paths. We’re very good at learning what the next step is in the chain and preparing ourselves and doing that very well. Consider the pre-med student who mapped out every prerequisite and extracurricular activity, and every shadowing opportunity - not because anyone told them to, but because those are the next steps required. Medicine selects for exactly that skill: executing a well-defined path with precision and discipline. Furthermore, during the course of either education, training, or practice, things can be so busy and time can be so scarce that there’s very little bandwidth to think about and consider other career alternatives or paths. A specialist may want to write publicly to clarify their ideas and create unexpected opportunities, but may not necessarily have the time in their schedule to do so.

By the time the bandwidth appears in mid-career, the script has started to feel normal. Not chosen - just normal. And there’s a meaningful difference between the two.

Your training path is over, but your professional life is not. The rewards that are coming to you can be some variation of the same. More volume, more responsibility, more titles and committees. You may have more credibility, but not yet have the language for using that credibility in a different way.

Furthermore, when everyone around you is following the same path and executing the same script, alternatives can feel somewhat illegitimate. Lastly, financial pressures can create a sense of commitment to the path that financially sustains you.

While these things all make sense, we have to consider that there is a hidden cost here. One cost is lost optionality. Understanding that decisions that are made at an early age, such as age 24, when you make your specialty choice, can constrain your options down the line when you’re 44. This impacts your career architecture. This script essentially forecloses possibilities that you didn’t know existed. The more that you invest time into this path, the more calcified your identity becomes and the harder any deviation from that becomes.

A second cost is identity fragility. When your professional identity is built on one script, anything that threatens it can feel like a threat to who you are. AI changing your workflow feels existential. A difficult year feels like a crisis of the self rather than a difficult year. The narrower the identity, the more fragile it becomes.

The third cost is harder to name but easier to feel. It’s the quiet discovery - often in mid-career, often on a Tuesday morning - that the script delivered exactly what it said it would. But what it promised isn’t actually what you wanted. The script succeeded - but the question is whether it succeeded at the right thing.

The script did exactly what it was designed to do. The question is whether it was designed for you - or designed by you.

The problem which most physicians intuitively realize is that even if you wanted to follow this script for the next 20 years, there are accelerating external forces that are making it harder to do so and that are threatening to break this model. This script was designed for a world and an environment that no longer exists. One huge disruptor is AI and workflow changes. And we know that the way physicians are performing their work is changing faster than the script can adapt to. We understand that AI literacy is becoming a career asset and may eventually become a requisite, but it’s not part of the default career script. Another driver is productivity pressures and reimbursement declines. The economics to sustain a clinical practice are becoming increasingly strained. Pure clinical careers are becoming financially less rewarding, adjusted for the amount of work input relative to the alternatives. Healthcare consolidation and the rise of employed physician models have reduced the autonomy the default script assumed. We have to understand that designing our own career architecture is no longer a luxury, but rather a necessity. It’s a shift for the world physicians are actually operating in.

The good news is that there is a possibility around the corner to address this Physician Optionality Problem. While we understand that there is a script executor who essentially follows the default path, reacts to situations and opportunities as they arise, and measures success by external metrics, we also understand that there is an alternative. The alternative isn’t dramatic reinvention. It’s a different orientation to the same career. For example, you can be a clinician negotiating an AI implementation role within your institution. Or you can be a physician using advisory work, consulting, or teaching as an expansion layer as opposed to an escape pathway. The metric shifts towards intrinsic variables where success is measured against the barometer of alignment with your actual capabilities, skills, values, and interests.

Intentional physician career design and physician career architecture is all about asking different questions.

It’s not necessarily what’s the next step for me, but rather: what do I want to be building or creating over the next ten years?

Rather than asking what opportunity should I accept, ask: what opportunity should I create?

The question is not necessarily should I be clinical or non-clinical? It can instead be: should I follow an inherited path or an intentionally designed path?

This shift in perspective can generate a meaningfully different career.

The default physician career script was created for the average physician in 1996. You are not the average physician, and this is not 1996.

We should operate from a vantage point of physician evolution, not revolution. Your clinical skills and experience serve as your foundation, not as a constraint.

This is the progression we’ll be building out across the coming essays — starting with why Identity Compression makes the first move so hard.

In the next essay, we’ll take one specific driver of the Physician Optionality Problem -Identity Compression - and dive deep. Identity Compression is the deepest reason physicians stay stuck, and recognizing it is the first step toward redesigning it.

If this essay resonates with you, let me know. Which stage of the script hits hardest for you?

- Scott F. Cameron, MD

Radiologist. AI implementation leader. Angel investor. MRS Past President. Career architect.

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After I published that first essay, I heard back from physicians across multiple specialties, telling me that the feeling is real. Their responses were versions of the same message: “I thought it was just me.” Just because we acknowledge this feeling, however, doesn’t mean that we fully understand it - we have to dig deeper and discover the reasons why we feel this way. Why do we have this sense that despite all of our training, achievements, and abilities, we can feel constrained in a professional identity that is narrower than their skills should allow?

Physicians have many possible career paths and many forms of leverage that they can use, but medicine rarely equips them to truly understand what these options are or how to use them. This results in a wide gap between what physicians actually do, and what they are capable of doing. After recognizing this pattern, I’ve started calling it the Physician Optionality Problem. In the context of physician careers, we can think of different optionality domains that can impact the experience of one’s professional arc. For example, you have financial options, but you also have intellectual, creative, and professional options as well. Without recognizing these, you artificially constrain yourself. This isn’t a personal failing - this is a consequence of a system that is designed to have you perform in a narrow lane.

There are 4 main drivers of the Physician Optionality Problem.

Driver 1: Identity Compression

Becoming a physician requires tremendous time, energy, and sacrifice, focused on the goal of becoming a doctor. You form this identity over a timeframe of a decade or more, with each year invested providing additional reinforcement that the end-result is near. Once your goal has been achieved, there is a rightful sense of pride and ‘arrival’ at the destination. However, once you place this identity as so central to your sense of self, it can become solidified to the point that it is hard to see yourself as anything else. It’s in the way that you accept certain responsibilities as just ‘part of being a doctor’ - like the after hours or weekend shifts, or the clean-up charting in the evening - in a way that other people wouldn’t understand. These things are ‘part of the package’ of being able to be a doctor. But the very same thing that gave you fuel and direction in the early days of your journey can in some ways become a constraint. It becomes challenging to see yourself as anything other than an outstanding doctor practicing medicine in the way you were taught to do.

Driver 2: Path Rigidity

Another reason the Physician Optionality Problem exists is that the pathway to become a physician is relatively rigid and well-defined. From the early pre-med days of MCATs, to the core clerkships in medical school, to the checklists and SOAP notes on the rounds, medicine has historically followed a very prescriptive educational and developmental structure. Much of your roadmap is very well defined for you. Deviate from it and you may find yourself off of the road, in a dimly lit area without a flashlight. As such, you become guided along a path that has few branch points or opportunities for exploration along the way. Running career experiments or simultaneously entertaining very different outcomes at the same time becomes very challenging to do, especially when you consider how demanding medical education, training, and practice actually is.

Driver 3: Opportunity Blindness

Another major driver is being unaware of the options that are available to you. Much of this has to do with your environment. If you are in a place where physicians generally follow the same career path, you may not be exposed to new ideas and understand the different ways you could use your skills in medicine, outside of medicine, or in medical-adjacent fields. How can you learn about the different ways in which to innovate within your institution if you don’t have anyone role-modeling this for you? How can you know that it’s possible to create a conference, a new service line opportunity, or a writing platform if you haven’t seen or heard of others doing it? Artificial Intelligence is creating numerous opportunities for physicians to become involved in healthcare startups as well as within one’s own institutions - but where are the people who are talking about these things? If you don’t know what and where the opportunities are, then you won’t know how to act.

Driver 4: Leverage Underdevelopment

Finally, underdevelopment of different forms of leverage is a large part of the Physician Optionality Problem. Leverage exists in various forms - knowledge, capital, networks, platforms, and credibility. But nowhere in training are you ever taught how to fully understand these forms of leverage and how to activate them. You may have low financial leverage despite a high clinical income. You may have great writing skills and clinical expertise but no platform leverage. You may have deep domain knowledge in different aspects of medicine, but it doesn’t necessarily mean you can articulate to other members of the healthcare ecosystem what the value is that you truly bring, or how you can capture that value and utilize your leverage to optimize your position. If you don’t know, it limits your optionality.

Here’s why this matters now. The pressures have been building over the years - reimbursement challenges and productivity pressures, burnout and isolation, consolidation and the healthcare workforce crises. Liability concerns, defensive medicine, and administrative bloat are all leading to work hours creeping into the fringes of the day.

And now, artificial intelligence is completely re-shaping the way in which we deliver our work product - not only in terms of how we can make diagnoses, but also in terms of our workflows and tools, and even the ways in which we interact with our patients. The timing for positioning ourselves to fully use our true optionality matters. When we realize that external pressures are all shaping our careers and our experience more than ever, we understand that our autonomy is at risk and that our opportunity to be proactive in designing our future state may be narrower than we think. Physicians who think strategically about their careers will find themselves in a career that was designed by them instead of for them. For all the energy we have spent on wellness solutions to combat burnout, meditation and yoga cannot fix a career that is too small for you.

Ultimately, we have to move beyond a diagnosis and into treatment - so in the coming essays, I’m going to explore some specifics of what we as physicians can do about these problems. I’ve been thinking about specific frameworks - around the different forms of leverage that physicians have, around conducting career experiments instead of making career changes, and around what career architecture can look like when a physician designs a portfolio career. Evolution instead of revolution. More on that to come soon.

If the Physician Optionality Problem resonates, reach out and let me know. If you read those four drivers and recognized yourself, I’d love to hear from you and learn which one hit hardest.

- Scott F. Cameron, MD

Radiologist. AI implementation leader. Angel investor. MRS Past President. Career architect.

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When was the last time you felt genuinely excited about the long-term direction of your career?

Not about a recent accolade at work, or a patient satisfaction letter, or a case that went well, but excited about where you would be in 5, 10, 15 years or more from now? When did you have the sense that your career end-goal was something that you were truly energized by?

You may not have the answer to this. You strive to be great at what you do, without knowing if the final chapter of your career holds anything that is surprising or compelling.

The quiet but recurring question in the background keeps repeating - is there something more? It’s not necessarily burnout or fatigue - it may have a pinch of boredom or monotony - but it’s really about the question: Do I know what the potential versions of myself professionally even are?

The paradox of achievement

By every external measure, you are incredibly successful. A practicing physician, perhaps a specialist or subspecialist, respected for your expertise by your peers, respected in your community and in your social circles, and with all the conventional trappings of success - great income, vacation, home, and for many, a great family life as well.

But despite all of this, something is missing. In some ways, as time has gone on, you feel like your career has become more restrictive instead of more expansive. You may have more titles or responsibilities, but your feelings about future possibilities appear somewhat narrower instead of feeling like they are wide open.

Comparing yourself to your peers, many of them seem content or complacent - or just have a reluctant acceptance of the current state of things - and they aren’t necessarily being vocal about whether they’re feeling the same restlessness. You wonder to yourself - is this just a personal issue I’m having? Or is there something structural here? And since I have it so well in many respects, does it sound ungrateful of me to even be asking these questions? And so the conversation is suppressed before it ever gets vocalized.

This questioning tends to hit most acutely between the ages of 38 and 52. When the initial trajectory of one’s career plateaus a bit, and the next one or two decades on the horizon seem like they hold the potential for sameness or monotony. At this point, you’ve gotten into a rhythm which is working well in many respects, and you just don’t know if or how you’re going to break out of it…. and whether it’s even worth it to try.

Why this happens

A big part of why this happens is a structural one. It’s not a personal or character issue - it’s a design issue.

The first reason why this happens is the script. Medicine is a very well-defined pathway, with a very particular set of steps that leads to the desired outcome of being a physician. The journey is so well defined and rigorous that by the time you reach the end of the path, you may have forgotten that you have any control at all over your destination. Physicians become great at executing the script, but not necessarily great at the intentional design of one.

The second reason why this happens is narrow-mindedness. Medicine has its own ecosystem that tends to echo the same ideas within it. You are in close contact with peers in the same role in the same institution following the same path … and who measure their success by the same metrics. Possibilities available outside of the typical path may not be discussed, or you may not even be aware of them.

The third reason why this happens is a deep sense of professional identity. When you have invested so much of your time and energy into becoming a physician, and made so many sacrifices along the way, and can finally contribute to society in such as meaningful way, this becomes a core part of your identity as a human being - above and beyond a mere vocation. There is a sense of deep pride in knowing yourself as a ‘doctor’. There is the deep admiration when your parent introduces you as “the doctor”. And so ironically, by mid-career, the very thing that anchored you and gave you the strongest resonance early on can start to become a limiter to your other possibilities.

And the fourth reason this may happen relates to something more subtle: mild suspicion or awkwardness surrounding the conversation of ambition and branching out. Wanting to experiment - or even the sense of wanting more - can feel selfish or unappreciative to some, especially when they see what you have already achieved. Also, physicians tend to be risk averse, and so they may suppress these feelings and put their head down and continue to work as they’ve always done.

It doesn’t have to be this way

We live in a world in which physicians are allowed to explore, have ideas and expand. You don’t have to do this by leaving medicine and pulling the ripcord, but you can do it by building upon the foundation that you already have.

Some of this could involve innovation and projects at your own institution. It may involve work with startups, advisory, or consulting. It may involve writing on a variety of topics, which could in turn create new ideas and opportunities. Some of this could involve investing in different parts of the health care ecosystem. And some of this could relate to strategic personal and professional positioning when rapidly developing artificial Intelligence is starting to reshape what physician careers look like.

These paths don’t necessarily involve ways to escape medicine, but rather, they are ways to build upon the advantage that you already have, using it as an anchor to create a richer and more interesting professional identity.

One of the commonalities around physicians that have more interesting lives and careers is that they’ve been much more intentional about the ways that they’ve built it. Instead of inheriting a pre defined formula and pathway, they’ve created their own custom solution. They are the designers and not just the executors of a plan that someone else gave them.

Why I’m writing this

I’ve been thinking about these questions for a while - because I’ve been grappling with them myself. I’m a successful mid-career physician who has been experimenting and learning for years, while trying to design a more interesting and purposeful career without leaving medicine. I’ve learned a lot along the way about what I’m starting to think of as optionality, leverage, and the intentional design of physician careers, and I want to share what I think it means for us.

If this resonates, I’d love to hear from you. I’ll be writing more about these topics - which I’ll be referring to as the architecture of modern physician careers. I think it matters to us as physicians, and I think the conversation is long overdue.

- Scott F. Cameron, MD

Radiologist. AI implementation leader. Angel investor. MRS Past President. Career architect.