Category: Providers

Doctors Want Their AI Dividend

Posted on by Jason Barry

Doximity’s 2026 Physician Compensation Report told a familiar story with an unexpected plot twist. Modest raises are still getting outpaced by not-so-modest inflation, but physicians now want a slice of all the AI-driven productivity gains.

Average physician pay rose 2% in 2025. The headline stat from nearly 23k surveys marked a significant slowdown from +3.7% the year before. It also trailed full-year inflation of 2.7%.

  • Neurosurgery once again led all specialties at $829k, interventional radiology grew fastest at 10.8%, and radiology was the only specialty to crack the top 10 for growth two years running.
  • The surgical specialist premium over primary care widened to 90.1% (from 87.3%), reversing three years of narrowing, while the gender pay gap sat unchanged at 26%.

The bigger story was AI’s growing impact. When Doximity asked who should primarily benefit financially if AI lets physicians complete more clinical work in the same amount of time, physicians primarily nominated themselves.

  • 44% said physicians (rising to 50% among PCPs), 20% said the gains should be shared, 17% picked patients, 11% picked their employers, and a whopping 2% picked payors.
  • There’s less agreement on the mechanics. 36% said physician compensation for a service should change if AI substantially reduces their time or effort for that service, while 43% said it should stay put.

Burnout is the bargaining power. The report lays out some compelling reasons why physicians feel they deserve some AI upside, and why they might actually be able to get it.

  • 82% of docs report being overworked, 66% are considering a career change, and the share considering early retirement jumped from 34% to 46% in a single year.
  • Those are some scary numbers all around, and despite all of the new tech promising to make life easier, 76% of physicians would trade lower pay for more autonomy or work-life balance.
  • Health systems and physician employers could try to bank all the AI efficiency gains for themselves, but they’re negotiating with a workforce that’s already eyeing the exits.

The Takeaway

Most payment models in healthcare ultimately put a price on physician time, so there’s inevitably going to be some serious discussions when AI starts impacting that time. Doximity’s report just showed that physicians are already pulling up chairs to the negotiating table.

The Hidden Bias in Portal Message Triage

Posted on by Jason Barry

Most patients assume that a portal message sent to their doctor goes to their doctor, but a new study in JAMA Network Open suggests that how it’s written could decide whether it ever gets there.

Here’s the setup. Portal messages land in a shared pool where a triage nurse or medical assistant makes a snap call: handle it themselves, or forward it to the doc.

  • Researchers analyzed 3.6M portal messages at Mass General Brigham, finding that just 32% got a reply from the clinician they were addressed to (77.5% heard back from anyone).
  • Prior work from lead author Mitchell Tang showed that historically marginalized patients fare worse in that process, and the new data agrees: Black patients were 3.7 percentage points less likely than White patients to hear back from their own clinician.

It isn’t the advice patients ask for. The authors ran NLP across a million threads to separate message content from writing style, and content explained just 5.7% of the Black-White response gap.

It’s how they ask. Writing style – length, sentiment, punctuation, and especially the greeting – explained 48% of the Black-White gap, 34.9% of the Hispanic-White gap, 60.5% of the education gap, and 42.8% of the Medicaid-commercial gap.

  • Messages opening with the clinician’s name (“Dear Dr. Tang”) got a response from that clinician 38.7% of the time versus 25.7% with no greeting, and Medicaid patients were far less likely to use one.
  • Longer messages and expressive punctuation also outperformed, while messages containing “please” fared worse. Manners are apparently negotiable, but name-dropping is not.

Here’s the good news. The authors see style bias as far more fixable than demographic bias.

  • Triage teams probably don’t know it exists, portal composers could help structure messages, patient-facing AI can assist with drafting, and AI triage could extract the clinical signal from the stylistic noise – as long as models trained on human triage don’t inherit the same habits.

The Takeaway

Triage teams are making split-second calls to tackle skyrocketing message volumes, so polish is getting mistaken for priority. Health systems now have a clearly labeled bias to design out of their in-baskets, but until they do, patients should probably brush up on their portal etiquette.

Epic Dominates, But Don’t Discount Competitors

Posted on by Jack Troy

Epic’s empire has reached, well, epic proportions. The software goliath’s grip on health systems gets tighter by the day, but a new report from startup studio Redesign Health doesn’t count out David just yet. Pencils up, founders. 

Redesign Health talked to the big wigs. Here’s a quick look at the survey group. 

  • A total of 112 execs at U.S. health systems served by Epic gave their thoughts. 
  • Two-thirds get final say on clinical and administrative purchasing, and the rest hold at least some official sway in these decisions. 

Most seemed pretty content with Epic. The platform has a quality edge to some, though its sheer size looks to be influencing things. Blink twice and we’ll call Oracle.

  • A huge majority (71%) described their system as “Epic-first.”
  • 80% expect prioritization of Epic going forward vs. 6% for external solutions. 
  • Epic is winning because of easy integration (50%), superior capabilities (48%), being “good enough” vs. alternatives (48%), and cost effectiveness (47%).

There’s room for competition. Execs placed the likelihood of another vendor matching Epic in various arenas on a one-to-five scale, and were generally open to outsiders. 

  • The greatest opportunities lie in imaging (3.52), quality tracking (3.51), and discharge and transfers (3.51).
  • Epic is most entrenched when it comes to patient flow (3.16), interoperability and integration (3.21), and non-imaging clinical decision support (3.22). 

But if you come at the king, you best make sure your product rocks. To ditch Epic, decision-makers must be confident they’ll get major results, and fast. 

  • Nearly half (49%) said external vendors must show significantly higher ROI and/or better outcomes, while just 18% grade Epic and its competitors on the same scale. 
  • It tracks that 63% ranked easy integration as important, with faster time to value close behind at 59%.

The Takeaway

Redesign Health’s report on Epic could serve as a roadmap for other companies to score some victories in the battle for market share. Those looking for one simple trick that Epic doesn’t want you to know will be disappointed, though. The broad strokes lesson is to make a product so good it’s irresistible. 

Study Questions Value of Management Consultants in Healthcare

Posted on by Jason Barry

If hospitals spend billions of dollars on management consultants, they will at least get:

  • A) stronger finances
  • B) better quality of care
  • C) streamlined operations
  • D) none of the above

The correct answer: D as in Deloitte! You guessed it, at least according to a new study in JAMA.

  • Researchers analyzed 2,343 non-profit hospitals in the U.S. from 2009 to 2023, finding that they collectively spent over $7.8B on management consulting over that period.
  • More than 20% of the hospitals brought on consultants, and the hefty total in the previous bullet means they spent an average of $15.7M for their services.

Here’s what that got them. Researchers compared 306 hospitals that enlisted management consultants for the first time during the study period to 513 matched hospitals that toughed it out on their own.

  • Despite the substantial investment, the study found “little evidence of substantial, statistically significant, or systematic improvements” attributable to the consulting engagements.

Consultants couldn’t catch a break. The analysis showed that the hospitals that hired them saw no significant impact across any of the primary measures.

Not the financial measures. 

  • Net patient revenue was down 2.22% (P = .14).
  • Total margin was down 0.19 percentage points (P = .71).

Not the operational measures. 

  • Inpatient length of stay was up 1.71% (P = .10).
  • Total inpatient days were up 0.29% (P = .85).

Not the quality measures.

  • All insignificant, besides 30-day stroke readmissions: up 1.37 percentage points (P = .03).

Big results, with limitations. An accompanying editorial applauded the analysis, but pointed out that struggling hospitals are also more likely to seek outside help. Future research should investigate this selection bias and “the factors that predict a hospital’s decision to hire a consulting firm.”

The Takeaway

High P-values don’t mean that management consultants aren’t making an impact. They just mean that the most notable study to investigate the impact couldn’t find one…

OpenAI Launches ChatGPT for Clinicians

Posted on by Jason Barry

OpenAI is doubling down on providers, and this time around it’s going direct-to-docs with ChatGPT for Clinicians.

ChatGPT-5.4, but for clinicians. OpenAI’s medically-tuned version of ChatGPT uses the same engine as GPT-5.4, with specialized training to optimize it for clinical workflows and administrative tasks.

  • Better yet, it’s free for any verified physician, NP, PA, or pharmacist in the U.S.

ChatGPT for Clinicians includes:

  • Access to GPT-5.4 and OpenAI’s other models (increased limits for clinical tasks).
  • Skills for repeatable workflows (like drafting referral letters and patient instructions).
  • Clinical search based on “millions of peer-reviewed sources” (details were sparse).
  • Optional support for HIPAA compliance (through a BAA for eligible accounts).

ChatGPT for Clinicians doesn’t include:

  • Connectors to the CMS Coverage Database, NPI Registry, or ICD-10. Not impossible.
  • Broader platform advantages like integrated drug information or telehealth.
  • Evidence from big name partners that’s contextualized to the encounter.
  • HIPAA compliance out-of-the-box.

All that said, the performance talks. ChatGPT for Clinicians was launched alongside HealthBench Professional, OpenAI’s new benchmark built from real clinical conversations.

  • It grades models on chat tasks across three use cases (care consults, documentation, and medical research), with physician-authored scenarios and rubrics, as well as scoring designed to reflect real-world performance.
  • As you might expect, OpenAI’s new tool did great on OpenAI’s new benchmark. ChatGPT for Clinicians outperformed Claude Opus 4.7, Gemini 3.1 Pro, and even specialty-matched physicians with unlimited time and web access.

What happened to ChatGPT for Healthcare? OpenAI launched ChatGPT for Healthcare just a few short months ago to help health systems with enterprise-wide deployments, but now it’s taking “the next step” by bringing ChatGPT straight to individual clinicians so that “AGI benefits all of humanity.”

The Takeaway

Whether OpenAI is pursuing an altruistic mission or hedging slow progress in the enterprise arena, millions of clinicians already use ChatGPT to support their care, and now they have a fine-tuned version that won’t break the bank.

Shrinkflation Hits Healthcare

Posted on by Jason Barry

Shrinkflation is hitting healthcare, and patients aren’t too happy about longer waits for shorter visits.

NYC Health and Hospitals rocked the boat last week after telling its primary care physicians to slash appointment times in half to 20 minutes, so they could squeeze in more patients.

  • The public health system is grappling with 50,000 new primary care patients since 2021, which caused wait times to double to an average of 22 days.
  • It’s a rough situation, and the physicians are understandably worried that shorter appointments will only hurt care quality and contribute to even more burnout as NYC HH was already struggling to compete with its private counterparts for clinical staff.

Nearly 1 in 5 patients now have to wait over a month before seeing a physician, with 43% reporting longer waits since the pandemic.

  • Rising patient volumes and pent-up demand were the stars of the show during health systems’ Q2 investor calls, but the supply of providers has struggled to keep up.
  • Ramping up physician training and recruitment hasn’t put much of a dent in the issue, and desperate systems are turning to shrinkflation to (temporarily) balance the equation. 

A vicious cycle gets created when the escalating needs of an aging population get answered with less care for individual patients. Worse care only causes demand to grow faster, which is why new solutions are needed to break the cycle.

  • Sutter Health told Axios that it’s investing in scheduling and referral tools to speed up wait times and streamline administrative workflows. Sounds better than 20 min visits.
  • Providence said that it’s been leaning in on capacity optimization software to identify scheduling gaps and ensure that its surgical suites are operating with limited downtime.

While not every health system has the same resources as Sutter or Providence, most could probably avoid some costly headaches by incorporating lessons from the success of their peers, like not trading short-term solutions – shrinkflation – for bigger problems down the road. 

The Takeaway

Times are tough, but shrinkflation is a brittle crutch.

How Much Will GLP-1s Change Hospitals?

Posted on by Jason Barry

When a new drug class bursts onto the scene as fast and furious as GLP-1s, hospitals start wondering whether a single medication can force them to rethink their entire model.

Norman Regional Health System in Oklahoma is blaming the diabetes management and weight loss drugs for prompting it to shutter its bariatric surgery center after patient volumes plummeted 30% within just the last year.

  • A Philadelphia system recently cited similar reasons for canceling its own bariatric surgery unit expansion plans, and other providers are actively revisiting where they want to allocate their growth capital.
  • Direct-to-consumer marketing and expanded coverage has led to roughly 1 in 8 U.S. adults reporting GLP-1 use, with analysts predicting that 30M Americans could be taking the drugs by 2030.

The roaring appetite for these medications adds to a number of other trends already impacting hospital footprints, such as new care delivery models and a post-pandemic shift to remote care.

  • Hospitals are now faced with the unenviable task of recalculating utilization forecasts for everything from diabetes and cardiac care to orthopedics and joint replacements.

Although it might still be too early for long-term capital planning, hospitals can turn to other recent advances like statins to glean some important lessons.

  • Statins were originally projected to make a massive impact on cardiovascular care volumes, but it turned out that patients were just older before needing those services.
  • Statins also contributed to longer life expectancies, and while the jury’s still out on whether GLP-1s will do the same, more people living past 65 would cause Medicare’s role as the country’s largest healthcare consumer to grow, meaning less price elasticity for many hospitals.

Hospitals don’t yet have answers to the long-term effectiveness of GLP-1s for managing chronic conditions or increasing life expectancy, but they do have the questions: 

  • Which service lines will lose volume? 
  • Which service lines will see more volume as the population ages?
  • How would these volume shifts affect payor mix?
  • What operational changes have to happen to sustain financial performance?

The Takeaway

GLP-1s have arrived in a big way, raising important questions about the changes hospitals will need to make to adapt. Those questions will take time to answer, but now’s the time to start thinking about them.

Alternative Staffing Models Harming Patients

Posted on by Jason Barry

New research in Medical Care found that hospitals opting to replace registered nurses with non-RN staff could be sacrificing patient safety for short-term financial gains.

This was one of the largest-ever studies investigating the tradeoff between RNs and lower-wage labor, yet it received surprisingly little coverage given the implications of its findings.

UPenn researchers analyzed clinical and claims data for 6.5 million Medicare patients across 2,676 US hospitals in 2019, finding that every 10 percentage-point reduction in RNs was associated with:

  • 7% higher odds of in-hospital death
  • 1% higher odds of readmission
  • 2% increase in expected days
  • “Significantly” lower patient satisfaction

Hospitals are often pressured to pursue “team nursing” models for the immediate financial lift of substituting RNs with nurses’ aides or licensed practical nurses, but the authors warn that the true impact of using less skilled workers is likely the exact opposite.

  • The study estimates that a 10 percentage-point reduction in RNs would result in nearly 11k avoidable deaths annually and 5,207 preventable readmissions.
  • That translates into roughly $68.5M of additional Medicare costs each year, with hospitals also losing nearly $3B annually because of patients requiring longer stays.

Then why do hospitals continue substituting RNs with lower-wage staff? From the patient perspective, the negative impact on outcomes – let alone mortality – should stop the idea of lowering the skill-mix in its tracks. 

  • That said, the average hospital sees an instant cost reduction of $31.94 per patient day for every 10 percentage-point reduction in RNs to total nursing staff.

The financial near-sightedness of that $31.94 cost reduction blinds hospitals to an estimated $66.03 of lost revenue per patient day for the same 10pp reduction in skill-mix… in other words the expected ROI is more than a two-fold loss.

The Takeaway

Nursing budgets are a huge slice of the hospital expense pie, making them a go-to target when leadership teams are looking to make cuts to fund other areas. This study reaches the paradoxical conclusion that the reason hospitals don’t have funds for other areas could be because they aren’t investing enough in the nurses they’re thinking of cutting.

Physician Compensation Rebounds

Posted on by Jason Barry

The numbers are in. Doximity’s always-anticipated Physician Compensation Report showed that overall compensation grew 5.9% last year – a welcome rebound after the 2.4% dip in 2022. 

Survey responses from 33k doctors brought more good news than that, with medicine’s gender wage gap narrowing to 23%, down from 26% in 2022.

  • Decent improvement, but women physicians are still taking home an average of $102k less than men after controlling for specialty, location, and experience.

Neurosurgeons continued to top the charts at $764k, nearly 4X the annual compensation of their pediatric endocrinologist peers at the bottom of the totem pole ($217k).

Other interesting highlights from the report included the fact that 81% of physicians reported feeling overworked, causing many to consider an employment change (59%) or early retirement (30%).

  • 88% of physicians also said that their practice has been impacted by the physician shortage, three-quarters of which described the impact as “moderate” or “severe.”
  • Funnily enough, the physician shortage wasn’t even the leading contributor to burnout, which 70% of respondents pinned squarely on administrative burden.

Despite recording a slight increase, total physician compensation has dropped 26% since 2001 when accounting for inflation. As it currently stands, only 40% of physicians are happy with their compensation, and more of these disgruntled doctors are unfortunately eyeing the exit.

The Takeaway

Physicians are still overworked and the wage gap is barely moving in the right direction, but at least they can rest easy knowing inflation is barely eating into their total compensation…

Cross-Market Mergers Aren’t For the Patients

Posted on by Jason Barry

Make sure you’re sitting down for this one, because new research suggests that cross-market hospital mergers aren’t doing patient wallets any favors.

To investigate the impact of cross-market mergers on both prices and quality, researchers rounded up 214 hospitals that acquired hospitals further than 50 miles away, then compared them to 955 control hospitals without any merger activity during the study period. This was also the first study to use claims data to back its findings.

Six years after acquisition, acquirers had increased their prices for patients by an average of 12.9% relative to control hospitals, yet saw no discernible impact on mortality or readmissions.

  • The impact was even higher among serial acquirers with at least four separate acquisitions, which increased prices by a steep 16.3%. This wasn’t a small subset either, representing 45% of the M&A hospital group.
  • On top of that, there was a 21.8% price increase when the target’s market share was greater than the acquirer’s (vs. 9.7% when the opposite was true), which makes sense as smaller acquirers have more to gain from acquiring an entity with more market power.

There have been a couple of other studies examining the impact of cross-market mergers, but this was the first to use claims data to untangle some of the factors driving the price effects (serial acquisitions, target size) while showing no significant impact on quality.

Although the mechanisms behind the price effects weren’t within scope, there are a few potential reasons that likely contributed.

  • Common customers – If the target and acquirer hospitals both share the same customer, having a larger operational footprint improves bargaining power (e.g. employers need provider networks that span multiple patient markets if they have employees in multiple markets).
  • Tying – A health system with a strong position in one market could tie its services to a second market (e.g. a cutthroat system could operate at a loss in a second market to drive out competitors while staying afloat using margin from its primary market).
  • Change in control – Acquirer hospitals are able to increase prices at the target because it wasn’t maximizing profit for whatever reason. Given the increases this study shows at the acquirers themselves (which by definition didn’t change control), this one is probably ruled out.

The Takeaway

All-in-all, the evidence is mounting that competing hospitals don’t make massive acquisitions for altruistic reasons (earth-shattering, we know). If the scale wasn’t already tipped toward needing more antitrust scrutiny of cross-market mergers, this study seems to get us past the usual conclusion of “more research is needed.”

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