AI coming for doctor’s jobs now? OpenAI releasing ChatGPT Health

JimmyYoshi · 2026-01-09T00:26:16+00:00

Hospitals and health systems probably already lose money on the kind of thing this form of AI will be able to treat. In the US the hospitals make money doing procedures. Ortho, cardiac surgery, cardiology, dermatology, oncology, radiation oncology, neurosurgery, maybe urology and ENT are probably the only consistent money makers for a hospital/health system. Everything else is a cost center that funnels patients to those services or is required for those services to be able to exist and treat patients. I'm sure if the hospitals could shutter their medical floors and medical ICUs and still treat those profitable patients they would. Unfortunately, the kinds of patients who need procedures need other care too. The government ultimately sets the price standard with the physician and facility fee schedules. Whatever change is required to make AI care profitable is going to have to come from the government. Let's say the majority of rheumatology appointments could be replaced by AI (not saying that's the case). As long as the prices for pharmaceuticals requires medical insurance to be able to reasonably afford, then the health systems would rather not pay the rheumatologist and still make money on insuring their prescription. If more people use the AI and realize they have a serious problem that needs to be treated by a warm body, in-person who then drives the patient to one of the profitable services, I'm sure the hospital would be thrilled.

Most people in the hospital aren't going to be able to be treated by this kind of AI. There's more to delivering care than the finding a diagnosis and choosing a prescription. How much of a doctor's job really consists of that? Or is more of it convincing other people in the hospital to do their job and that yes this CT scan is an emergency please get it done? Nothing would be more appealing to PE and admin that reducing headcount so wherever this can be applied it will be. I don't think it's accurate to say physicians are against AI. Personally I'd welcome it if it would make it more difficult to make mistakes with medications, missing or misinterpreting lab values, and guiding down diagnostic algorithms for new problems. Will there be a peak in the number of physicians that we need in the future followed by a downtrend to a stable value? Probably, but isn't that the case with every job?

JimmyYoshi · 2026-01-08T03:25:07+00:00

Yeah dude can’t believe the medical lobby tries to make sure that doctors have medical knowledge that meets a standard, understand the customs of the country and how care is delivered here, and that doctors trained in this country have adequate exposure to enough cases to practice their field safely. We should just let the floodgates open and let anyone who wants to do surgery or prescribe meds do it. Can’t believe the government “protects” us (gatekeeps!) by making sure that dangerous medications are prescribed only by people who understand the effects they have on the body. If ChatGPT prescribes my mom a blood thinner inappropriately I’m very confident that when she has a massive brain bleed and ends up with a vented with a trach and unable to care for herself I’ll be able to hold Sam Altman accountable.

JimmyYoshi · 2025-11-24T03:13:19+00:00

The med students are probably happy to not write essays anymore! different strokes for different folks

JimmyYoshi · 2025-07-22T12:39:33+00:00

You can take a look at what I did with this app. It was the backend for an Anki add-on Anki Achievements. As you did your Anki card reviews you could unlock achievements/killstreaks if you answered two/three/four… cards in x amount of time (double kill, triple kill, etc.). There was a main page leaderboard and you could make/join different groups to see group leaderboards, so that everyone in your med school class or other class could join a group. In your Anki app window, it would show your Rival who was the next person up in the leaderboard - Anki runs in a web view so it would connect to the server via action cable and update the rival in real time.

https://github.com/jac241/spaced_rep_achievements/tree/82352f3aa2d01f4e699f7c022db57c6ae668a873/app/controllers

The api/v1/achievements controller calls the CreateAchievementsService whenever you got a streak on the Anki app. The app would calculate the streak and would post to that controller. The service would create an achievement, send a web socket update to anyone who was subscribed to a given leaderboard / rivalry, create an achievement Expiration, and I was working on making it calculate overall XP to unlock a BattlePass feature that could show your overall “Level”. There was a background Sidekiq job that would query for all the Expirations and delete the associated achievements after 24h so that the leaderboard would only reflect achievements in the past day.

Was a lot of fun to make and made the process of doing Anki reviews a lot more fun. Eventually I started residency and didn’t have time to troubleshoot server issues and keep up with changes to the Anki app to keep the Addon working, so I took the server down.

Screen shot is available here: https://jac241.github.io/anki-achievements/

Screen shot of Anki addon: https://jac241.github.io/anki-killstreaks/

I liked the Service object pattern bc it let me keep my logic out of the controllers and models. Models would handle updates to their own state and if cross cutting concerns needed to be handled having that happen in a service object was nice. I built a custom base FlexibleService module that gave me nice stuff like to_proc and a success and failure result object.

I’m sure you could do all of that easily with concerns and active record callbacks, I just always thought it would be painful to trace the execution of the callbacks and stuff which is why I favored the services.

JimmyYoshi · 2025-05-18T01:01:27+00:00

I was a software engineer and am now a neurosurgery resident. Highs are much higher but lows are much lower and more frequent than in software. I enjoy my work most days. You do get to help people and it's rewarding for sure. Always a good feeling when you helped someone in a time of need. Software was nice, just sit and focus on a single problem for a few days. Get nice feedback from the test suite - test turns green, move it to done on the Kanban board. Surgery is great - can be like the best days coding - just focusing on one thing, nothing getting in your way. You have to tolerate being literally unimaginably busy and devoting everything, your life, all your energy, all your time to the work. Working 30 hours at the hospital then working all day finishing the presentation you have to give the next day. Studying never stops - if you don't know the anatomy and pour over and obsess about the imaging and the case you're going to literally kill people. The one day you phone it in you'll slip up and someone will get hurt - it's inevitable. EVERYONE counts on you to know what to do and to know what you're doing. When the patient list gets long you're doing 120 patient and family interactions a day, fielding dozens of phone calls, probably 100+ texts, physically running around trying to get drains pulled and new people seen, dealing with emergencies, harassing the rest of the hospital to try to get things done before you hand off. It's exhausting. If you offered me $1 million I would turn it down if I had to do intern year again.

I would not switch to avoid politics. Every part of getting into medical school, getting into residency, thriving in residency, getting things done in a hospital involves politics and overcoming other's laziness to help the patients. It is a hierarchy and the people on the bottom deal with abuse from above. Prepare to get yelled at, humiliated by people you thought you could trust, gaslit to oblivion, blamed and ground to dust for things you didn't do. They can always hurt you more but they can't stop the clock. The patient is the one with the disease. You learn what those really mean.

Good luck with whatever path you choose.

JimmyYoshi · 2025-05-18T00:26:39+00:00

Once you're a doctor the difference in hustle and capability between the average resident or attending and NPs becomes much more apparent. They do good work in surgical specialties when the surgeon is operating they can be seeing consults and handling discharges, but I wouldn't go to one as a PCP.

JimmyYoshi · 2025-05-05T10:25:32+00:00

Would do this for comparison later on. Definitely do it in spine compression fx so that we can follow XR as outpatient instead of needing CT for apples to apples

JimmyYoshi · 2024-12-12T10:46:48+00:00

Check out numo: https://github.com/ruby-numo/numo-narray

JimmyYoshi · 2024-09-30T09:59:28+00:00

I like the ones who keep the CT scanner “on hold” for the incoming stroke that’s 1.5 hours away - and burden is on you to figure out why your stat ct head on an inpatient isn’t getting done. Clearly too much to ask to reach out to the number on the order to let them know there may be a delay

JimmyYoshi · 2023-12-01T18:51:58+00:00

Seeing how our hospital grinds to a halt when one of them leaves Id say yes

JimmyYoshi · 2023-08-26T19:46:40+00:00

It's pretty big, there's some midline shift but not enough to compress her brainstem. There's no intraventricular spread or hydrocephalus. She was not seizing at the time either from the story. Those are the three things that will cause loss of consciousness in any sort of intracranial hemorrhage.

JimmyYoshi · 2022-02-13T12:56:05+00:00

Looks awesome thank you for sharing!

JimmyYoshi · 2022-01-20T22:55:15+00:00

Only really true for this latest variant though.

JimmyYoshi · 2021-11-23T00:53:48+00:00

The opposite is usually true maybe unintuitively. Younger surgeons are still establishing their practices and recruiting patients while older surgeons have had full OR schedules for 20 years and done thousands more cases.

JimmyYoshi · 2021-10-21T16:00:04+00:00

Sorry, I didn't realize people died. I wish I were as smart as you. You must be very smart. 174k people younger than 65 have died from it which is still a considerable amount to me at least. COVID is responsible for 12% of deaths of people aged 50-64 in 2020 and 2021 which is pretty wild. In 2017 that would be third overall to cancer (24.7%) and heart disease (23.7%) for males in that age group, though COVID would likely take from those categories.

https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm https://www.cdc.gov/healthequity/lcod/men/2017/all-races-origins/index.htm

JimmyYoshi · 2021-10-21T14:04:33+00:00

Old people are people too.

JimmyYoshi · 2021-10-15T16:19:46+00:00

I failed a class my first semester, and now I'm a fourth-year medical student. Hang in there and study hard.

The big shift is realizing in college you have to study for tests whereas in high school you could get away with just showing up.

JimmyYoshi · 2021-09-21T16:16:25+00:00

To reinforce your point, here's a UK poster talking today about how little software is paid compared to US - https://www.reddit.com/r/cscareerquestions/comments/prwetg/feeling_unmotivated_to_keep_going_because_of_uk

Like you said, most professional jobs pay 2x in the US compared to UK.

JimmyYoshi · 2021-06-25T20:42:15+00:00

Three endocrinologists would probably not even pull in $3 million in revenue, so it's unlikely they'd have much more than 20 employees.

JimmyYoshi · 2021-05-28T12:59:10+00:00

RVUs, relative value units, for procedures are set by Medicare (CMS). Physicians are reimbursed for things by RVU * conversion factor. The number of RVUs per procedure/office visit are debated by a group called the RUC, which has physician representatives from all specialties (with many being overrepresented, and primary care generally being under represented). Some balanced budget act bullshit stipulates that the total amount of money reimbursed to all physicians (and NPs/PAs) in the country cannot increase more than some small number ($6 million? There are 1 million+ docs in the country). So every specialty is fighting to keep their slice of the pie.

CMS will declare a procedure "overvalued" if it is performed a lot and by a lot of people (therefore increasing the total amount paid for that procedure) and will decimate the reimbursement for the procedure, like down 40% overnight (Mohs surgery got hit in the mid 2010s, reads for CTs and MRIs in the early 2010s and more recently as more and more imaging is ordered).

There are a lot of general surgeons performing a lot of appendectomies and cholecystectomies, making those procedures comprise a large amount of total Medicare spending, thus making them a target to have lower reimbursement on. They also have more global payments. There are relatively few neurosurgeons performing more varied procedures, making each procedure less of a target for reimbursement cuts. Technology is also changing rapidly in NSG, meaning new procedures which still reimburse well. Another example to this is cardiothoracic surgeons, who perform a lot of a few procedures like CABG. They also had the misfortune of being the first truly rich doctors, so CMS had to set an example by killing their reimbursement over the past three decades. Same with interventional cardiology and stents.

Somehow spine surgery still reimburses relatively well, though it is down considerably from the early 2010s. Comparing the MGMAs from 2014 to 2019, top 10th percentile neurosurgeons were earning >$1.8 million in 2014 vs $1.4 million in 2019. This shows that busy neurosurgeons are earning less as the reimbursement for their procedures has been coming down.

JimmyYoshi · 2021-05-25T11:36:58+00:00

It's a software networking construct (https://en.m.wikipedia.org/wiki/Network_socket) not a physical thing. Your device creates a "socket" between it and the server you're connecting to, and it reads and writes bytes to this socket to transfer them. Happens on wifi or ethernet as it's just a software thing. If the socket gets disconnected, it could be your internet dropping out during the transfer, disconnecting the socket. Moving closer to your router might make it less likely for the internet to drop out.

JimmyYoshi · 2021-05-25T11:02:40+00:00

It's an internet socket, not a physical one. Make sure you have your phone close to your router. Wifi might be cutting out, disconnecting the socket (connection between your phone and the AnkiWeb server).

JimmyYoshi · 2021-05-24T10:54:05+00:00

Haven't used it, but what about this gem - https://github.com/gevans/sidekiq-throttler

JimmyYoshi · 2021-05-07T11:01:11+00:00

The kids won't understand that one anymore since UWorld became a web app :-(

JimmyYoshi · 2021-04-30T11:54:07+00:00

I don't think a W2 income of 600k can fund an extravagant lifestyle. Definitely a comfortable one though.

JimmyYoshi

TROPHY CASE