The Root Cause · 2026-04-17 · 1h 21m
Key moments - from our scoring
Substance score
66 / 100
Five dimensions, 20 points each
Samir Qamar's unconventional path to medicine - shaped by his childhood as the son of a UN diplomat living across developing nations and Europe - positioned him to question American healthcare fundamentals that most physicians accept. After medical training in Dominica, England, and the Johns Hopkins system, he recognized the core problem: the fee-for-service model's requirement to see 30 patients in a morning made meaningful patient care impossible. This realization sparked his 2002 cold call to MDVIP's Darren Engelhardt about concierge medicine, leading to his launch in Pebble Beach as a resort physician. Over 25 years, Qamar has progressively scaled his impact from direct primary care to virtual technologies, and now to AI systems designed to reach millions rather than thousands. His trajectory reflects a consistent entrepreneurial drive: when each model hit its ceiling, he moved to the next layer of technology and distribution. For operators questioning healthcare delivery models, Qamar demonstrates how external perspective, financial realism, and ambitious scaling ambitions can reshape entire business categories within medicine.
Despite billing $2,000/hour at Pebble Beach, he realized seeing 25-30 patients daily for 25 years would only serve 150,000-180,000 patients in his lifetime, falling far short of his ambition to impact millions through scalable solutions.
Training in the Caribbean, England's socialized system, and the US fee-for-service model gave him comparative perspective; he noticed England's physicians relied heavily on physical exam skills while US practice defaulted to imaging and testing regardless of cost implications.
His residency required seeing 13 patients in a morning session with only 10-15 minutes each, making it impossible to build rapport or discuss preventive care - a structural inefficiency he realized was industry-wide and required a new business model.
As a second-year resident in 2002, he cold-called MDVIP after Googling 'concierge medicine,' spoke with their general counsel Darren Engelhardt, and learned how shrinking a patient panel to those paying a membership fee could enable longer visit times.
The episode references him launching or about to launch an innovative company focused on AI applications in healthcare, positioning it to scale impact across the planet rather than through traditional practice models.
Our reviewer’s read on each dimension, with quotes from the episode.
The episode contains substantive ideas about healthcare business models, AI implementation, and the shift from sick care to preventative care. However, much of the conversation is biographical narrative and soft discussion rather than dense, operational insight. The core insights (direct primary care model, AI for healthcare accessibility, physician roles evolving toward coaching) are real but not packed densely - they're interspersed with lengthy personal anecdotes and broad philosophical musing.
concierge medicine changed that entire mindset because you could then communicate with the patient by phone, by video, in other ways, because there was no fee involved anymore per visit
AI will change medical practice forever...the physicians now who turn to open evidence or other AI models aren't doing a disservice to patients. What they're doing is they're tapping into this vast medical database that will remind them what they need to know
Samir articulates some genuinely fresh angles - particularly his framing of health insurance vs. healthcare, the evolution from concierge to DPC to AI as a natural scaling progression, and the idea that AI tools should be built by clinicians, not tech companies dropping healthcare features. However, the core concepts (DPC model, AI democratizing knowledge, doctor as coach) are increasingly mainstream. His international perspective adds originality, but the core arguments recycle familiar healthcare critique.
health insurance is not in the business of health care. Health insurance is in the business of insurance...Healthcare is what you and I do in the room when the door closes
healthcare is one of those industries where disruption needs to come from within. All three of us can become patients, but our patients can't become doctors
Samir Qamar is a legitimate operator with 25 years in healthcare, from residency to founding multiple companies (MedLion, Medwand) to launching Astrid AI. He has real clinical experience, raised capital, achieved FDA clearance, and operates at scale. This is not a thought leader or consultant - he has built and sold companies. High caliber, though the episode lacks discussion of specific financial metrics, user adoption, or company valuations that would distinguish him further.
Medline was the first direct primary care company in California. Uh we opened an office in Mountain View, Silicon Valley
the company's doing well now and uh we got FDE clearance, which is a whole different thing, and it's it's off to the races for that company
The episode lacks hard data. Samir provides some specifics: $250k med school debt, $2,000/hour billing at Pebble Beach, 13-patient morning panel in residency, 150-180k patients over a career, six billionaires in his Pebble Beach panel. However, on Astrid (his main current project), there are almost no specifics: no user numbers, no clinical trial results, no adoption metrics, no revenue. The discussion of AI capabilities is conceptual, not evidenced. For a podcast about business operations, this is thin on numbers.
I graduated with about $250,000 in loans
I see twenty-five patients a day, thirty patients a day for twenty-five years. That means I would have taken care of about 150 to 180,000 patients total in my lifetime
The hosts ask reasonable follow-up questions and show genuine engagement. Erik pushes thoughtfully on patient perception of AI use by physicians, and Davin probes Samir's early insight into DPC. However, the conversation often meanders into comfortable agreement and biographical storytelling rather than testing claims. The hosts rarely challenge Samir's assertions (e.g., the bold claim that all cerebral work will be AI-driven, or the assumption that Astrid will scale globally without friction). Softball questions dominate; there's minimal productive disagreement or pushback.
So wait, you mean you you took a realist view to the whole situation?
I had a patient who I was meeting with on Wednesday who he's like I I'm sitting there and I'm asking m this doctor the question and he literally turns and says, Let me ask ChatGTP
Computed from the transcript - who did the talking, and the words that came up most.
Dr. Samir Qamar - one of the original founders of the Direct Primary Care movement and creator of MedLion, MedWand, and AstroDoc, joins Brothers, Dr. Erik Lundquist and Dr. Davin Lundquist, for a wide-ranging conversation shaped by a childhood spent across four continents with a UN-diplomat father. Samir traces his arc from Ross University to England's socialized NHS to Penn Medicine-Lancaster General, where as an intern he cold-called MDVIP from his scrubs after discovering concierge medicine. His first post-residency role was House Physician for Pebble Beach Resorts; that seeded MedLion, the nation's largest DPC network across 27 states, which in turn led to the MedWand - a handheld telemedicine device that lets remote clinicians capture real physical-exam data. His current obsession is AstroDoc and its AI health agent Astrid ("A System To Reinforce Infinite Doctors"), designed to be for billions of patients what Samir became for his own parents when they were sick.
Transcribed and scored by The B2B Podcast Index.
Erik: Well, Davin, we have another episode of the Root Cause Business of Medicine podcast. Erik: And this was one of my favorite episodes for sure. Erik: It was really fun to reconnect with Erik: uh Dr. Erik: Samir uh Qamar Qamar, I can never say his name right, who hopefully he'll forgive me.
Erik: But uh it it was just really fun Erik: to reconnect with him. Erik: I've known him for a while now and just always admired his entrepreneurial mind, uh his perspective and his ambition to Erik: changed the world in of healthcare um and thinking of the little guy out there in that in that process. Erik: What were some of the key takeaways from today's uh podcast and interview that that you had today Davin: Well, I think what's interesting is, you know, his background was from outside the US, you know, growing up.
Davin: And so he wasn't like locked into that sort of indoctrinated mindset of our US healthcare system and Davin: Um, I mean obviously he's a super smart guy and and very innovative, you know, tendency, entrepreneurial, you know, spirit about him, but Davin: I think that did maybe help him look at healthcare a little more fresh and and say, okay, rather than just saying, hey, where am I going to get a job in the system? Davin: He thought Davin: There's a better way to do this, you know, and and then he found a better way to do it and it's evolved Davin: uh to the point now where he's, you know, about to launch or has launched um a very innovative company that I think will have a big impact on healthcare across the planet.
Erik: Yeah, so if you want to know about the future of healthcare and where it's going and and how it who are the influencers in this field, I think you're gonna really enjoy Erik: today's podcast because um Dr. Erik: Samir Qamar is just an amazing individual and what he's already accomplished, but now what he is accomplishing in terms of Erik: the future of AI and how it's going to assist us in healthcare is is just amazing. Erik: It's a wonderful discussion. Erik: I know you'll enjoy it and uh we look forward to having you participate in the podcast.
Erik: Welcome to the Root Cause Business of Medicine podcast, where we explore what's broken in healthcare and what we can do about it. Erik: I'm Dr. Erik: Erik Lundquist and I've been practicing functional medicine for the past 15 to 20 years. Erik: I'm excited to co-host this podcast with my brother, Dr.
Davin: Davin Lundquist, who's just beginning his journey into functional medicine. Davin: We come from different points on the path. Davin: But we do share a common goal. Davin: We want to rethink how medicine is practiced and help others do the same.
Erik: The U. Erik: S. Erik: healthcare system is in crisis, rising costs, declining outcomes, and physician burnout at an all-time high. Erik: Hi.
Erik: But you know, we found a different way, another way, a better way. Davin: On this podcast, we dive into real stories from medical professionals who've stepped away from the traditional model, kinda like me. Davin: and have found a new purpose in integrative, functional, and alternative approaches to care. Erik: These are authentic conversations with practitioners and friends who've redefined success not just for themselves Erik: but for their patients and communities.
Erik: Whether you're a clinician feeling stuck, a student seeking direction, or just curious about what is possible, Erik: You're in the right place. Erik: This is the Root Cause Business of Medicine podcast. Erik: Well welcome to another episode of the Root Cause Business of Medicine podcast. Erik: And today our special guest is Erik: My good friend Samir Qamar.
Erik: Did I say your name right? Erik: I I actually didn't ask you how to say your name right, but Qamar is fine. Erik: Oh yeah. Erik: Great.
Erik: So Samir Qamar. Erik: um who I met um probably about sixteen years ago now and uh he was Erik: doing a direct primary care program that I was super interested and we met through a physician who we were hiring, um Dr. Erik: Narayan. Erik: um who was with our clinic for almost 10 years.
Erik: And uh we got connected that way and we've kind of been connected ever since. Erik: So sometimes a little Erik: Closer than others, but uh we've been able to reconnect recently and I'm super excited to have him share his story today Erik: Um, because he has a very unique background, um, and he's got a an amazing business and entrepreneurial mind, uh, particularly in the technology world. Erik: So I'm gonna let Sam um Samir actually introduce himself and kind of give us a little background on kind of where you did your your medical studies and then kind of what got you into Erik: moving one, you know, I will we'll call it the three segments.
Erik: The, you know, initially the direct primary care and then the the the virtual technology and then ultimately into AI technology. Samir: Thank you, Erik and Davin, for hosting this. Samir: Um Samir: I I had a very interesting background. Samir: My father was a diplomat for the United Nations, and so we lived Samir: In many countries, we were always US citizens, and uh that represented the US for his UN work.
Samir: And so when you're growing up around the world, you Samir: Like a doctor, start to look at human beings as all the same. Samir: Right? Samir: We we understand that human beings, regardless of culture, religion, beliefs, are essentially the same biologically in most cases. Samir: And that childhood started shaping many decisions that I made as an adult.
Samir: One of those decisions was, where would I go to medical school? Samir: At that time when I was applying, Samir: My parents lived in Italy where Dad was stationed for 20 years and to me my goal was to be a diplomat like my father. Samir: I wanted to Samir: have a little flag on my car like he did when he went to go meet dignitaries and I saw myself being at the WHO at that time, which was a big thing in health. Samir: Uh, dad worked for the Food and Agricultural Organization of the UN, which is the UN's largest division.
Samir: I wanted to work in healthcare. Samir: Uh, I'd always wanted to be a doctor, so Samir: I decided to go to a medical school that was WHO approved because I wanted to come back to the WHO, and that ended up being in the Caribbean. Samir: Uh so I actually flew on an airplane from Rome, Italy to Dominica to become a student at Ross University, which was, to me, as a young student, a great Samir: Decision to be near the beach and so forth. Samir: I ended up meeting my wife there as well.
Samir: Oh, that's it. Samir: We're still married today. Samir: This is nineteen ninety-five. Samir: And the studies at some of the bigger Caribbean schools are such that you do your basic sciences there and then you end up Samir: going elsewhere for your clinical work.
Samir: I opted to go to England at that time because I'd heard about socialized medicine being a big thing and I wanted experience what that was like. Samir: So I got to do that and it was it was great. Samir: We were in England for a year and then after a year I thought, you know, I better get some American experience as well. Samir: So I came back and said all of my core rotations and electives at Johns Hopkins affiliated.
Samir: places uh and that was a lot of fun. Samir: When I graduated, um Samir, let me just interrupt you really quick because I I'm curious would it Erik: Did you was that a stark difference in reality in terms of how medicine was practiced? Erik: One, what you saw in the Caribbean? Erik: When you saw what yeah I mean you grew up n really never experiencing American healthcare, right?
Erik: I mean, because you were always Erik: You spend a long time in Italy, you go to you go to the Caribbean, you go to England to do your clinical training, and then all of a sudden you show up in the US. Erik: What was that like? Samir: So, you know, as you may remember, when you were medical students, you're you're trying to just read and get ahead, take your exams. Samir: That's all that really matters.
Samir: It's in your clinicals that you start to experience Samir: being a doctor. Samir: So clinicals for me started in the Caribbean. Samir: I remember in our second year of medical school, they start Samir: having you rotate, um I think it was the Princess Margaret Hospital, which was fun. Samir: You get to wear a stethoscope, wear a white coat, start feeling like you're almost a doctor now.
Samir: And Samir: If you've ever practiced in a in a developing country, it's it is very different. Samir: You have limited supplies. Samir: You uh are quite revered amongst the local population because Samir: Healthcare providers there are are very uh noted as figures in the community. Samir: England was very different.
Samir: England was socialized medicine at its best. Samir: Uh okay, what do you do with a fall? Samir: No blood thinners, no head contact. Samir: Oh, CT scan of the head.
Samir: Oh no, we don't do that here. Samir: We look at the patient first, get the story, make sure there's symptoms and signs rather that would necessitate such an exam. Samir: Really? Samir: Uh so that was interesting.
Samir: You got to practice Samir: In a way, or learn how to practice in a way where the physical examination was given a lot of attention, our physical examination skills were sharpened quite a bit. Samir: I I remember there was a Samir: a stroke specialist who could tell which side of the brain the bleed was on by the way they were laying in bed. Samir: Um things like that that were considered magical now because now it's just get a CT scan. Samir: And then we come back to America uh to practice and it's CT scan for this, MRA scan for that, blood work, cost is no issue.
Samir: Well, you find out later it is an issue. Samir: Someone pays for that bill. Samir: And Samir: The training was very different. Samir: Um, so there was a big difference in the way medicine was practiced Samir: In the Caribbean as a developing country, in England as a socialized medical situation, and then here in the US where everything is privatized.
Samir: Uh so that opened up my eyes in many ways. Samir: And then later I ended up doing my family medicine residency. Samir: Well, I did a year of research first Samir: at Penn State and um HIV just because I wasn't sure what I wanted to do yet with my career. Samir: And uh Samir: I I I realized one thing.
Samir: I never wanted to do research again. Samir: That was the most boring thing I'd ever done in my life. Samir: I was a people person and so I ended up Samir: In family medicine, um at Lancaster General Hospital, which was the middle of Lancaster, Pennsylvania, uh Amish country. Samir: And uh it's where I picked up my bow tie habits for a long time.
Samir: I've dropped that habit now and Samir: where I ended up growing the beard. Samir: But that program was inducted into the Penn uh medicine program and uh is considered as you probably have heard as one of the better Samir: Drawing medicine, more rigorous draming medicine programs in the country 'cause it was an unopposed program. Samir: So it it was it was as close as to as house Samir: MD as you could get, where there were only a bunch of residents taking care of all the patients, doing everything in the hospital from deliveries to traumas to ICU rotations.
Samir: It was fantastic that training there. Samir: But it was while I was there uh that I realized I was not gonna practice medicine the way it was practiced in the US. Samir: And that was then the epiphany that led to concierge medicine. Erik: That's awesome.
Erik: Um I uh there's Erik: So much from that background. Erik: I think you you just came in with a different lens, right? Erik: You you were not exposed to the Erik: I I you know, and I I I mean this in a nice way, but the harshness of our m medical training. Erik: You know, I mean I think in uh uh in in the medical school Erik: training, it is it is extremely fear based in the United States.
Erik: And the I I I think that if you ask Erik: what any graduating physician's biggest fear is out of medical school, it's getting sued. Erik: And it's and and that's it that's not a way the the biggest fear should be that Erik: I'm not taking care of my patients well enough, right? Erik: It should be that I'm I'm not meeting them Erik: in such a way that's going to help transform their lives into a healthier, more optimal state. Erik: That should be our biggest fear.
Erik: And yet we come out of there thinking, I can't make this mistake, I can't make that mistake. Erik: I can't because if I do, I'm gonna get sued. Erik: And Erik: And then you get into residency and um, you know, I love that term, unopposed, right? Erik: Because most of us were in opposing Erik: uh residency programs where you would be, you know, well what about this?
Erik: And what about that? Erik: Why didn't you do this? Erik: And what you know and you failed here and you failed here. Erik: And uh it's just so Erik: It's this you come out of there just really, really struggling.
Erik: And I remember even in the middle of medical school contemplating dropping out. Erik: Like this is not why I went to meta into medicine and this is I'm I'm really being fooled and Erik: In my story, it was because I actually listened, went to a conference and listened to a physician who was doing integrative medicine and he was approaching Erik: his patients from a very holistic mindset where he was looking at their nutrition, looking at their spirituality, you know, offering solutions that were lifestyle-based.
Erik: And I was like, okay, there's there's there must be a place for me here at some point in time. Erik: I don't know how that road is gonna get me there, but you know, it's gonna get me there. Erik: So after residency then how where Erik: What did you you have this epiphany, um, but y you didn't go back to Italy or England, you stayed here. Erik: So what what what was next then in your journey?
Samir: So that's my wife's fault. Samir: The reason we didn't go back to Italy. Samir: Her parents were from California, and that's the end of that, but we'll leave it there. Samir: Um she was born and raised in California.
Samir: Uh Samir: I didn't want to be a burden to my parents. Samir: They came from a middle class background. Samir: They did very well Samir: But my dad, uh, who I consider a genius, finished his five year PhD program at Cornell in just two years. Samir: Uh.
Samir: And did it on a full scholarship. Samir: So Samir: I just wasn't raised to have my parents pay for my education. Samir: So I funded it myself. Samir: I got loans and all that.
Samir: And I graduated with about $250,000 in loans Samir: And now I'm starting to think, okay, life is about to get real. Samir: How much do family doctors get paid when they graduate? Samir: And I started looking at the contracts for the graduating seniors. Samir: And they were not impressive when you compared them to the contracts that the nearest versions and the orthopods were ready.
Samir: And I'm thinking, okay, my God, this is gonna take forever to pay off the loans. Samir: And I was always ambitious. Samir: Um Samir: My sister at that time was getting her MBA uh from Penn State. Samir: She was living with us while we were in residency.
Samir: And I would raid her closet when the medical journals would get Samir: cumbersome just to get a new perspective on things. Samir: And I really got into learning about how businesses are formed and so forth. Samir: And you link that back to my medical loan issues, student loan issues. Samir: And I'm thinking there is got to be a better way.
Samir: So that was one data point for me that just didn't leave me. Samir: The second was the way patients were being seen as outpatients. Samir: Our residency was, like I said, uh they made you work hard. Samir: And I remember in our first year, they introduced me to my panel of patients who I would follow for three years.
Samir: And it was during my first year as an intern I was asked to get ready to see my patient panel. Samir: I remember looking at that list, it was Samir: 13 people on there. Samir: I'm like, wow, okay, I've got all day to look at these folks. Samir: And they said, no, no, no, this is your morning session.
Samir: What what are you talking about? Samir: They said, no, no. Samir: This is your morning session. Samir: You get an average of about 10 to 15 minutes with each one.
Samir: And make make sure you remember time to dictate and and the they have to take vitals. Samir: And I did the math in my head and I'm like, oh my God, this this is how can you Samir: As a family doctor, how can you create that rapport? Samir: How can you talk about what Samir: is needed from a preventive standpoint. Samir: What if they come in with a major concern and right away I knew this was the wrong way to practice.
Samir: And what shocked me was this was the way it was practiced everywhere. Samir: It wasn't until residency that I realized Samir: That medicine is a business in America. Samir: Period. Samir: And none of us went to school to learn how to file insurance claims.
Samir: We Samir: didn't care about the money side. Samir: We're family doctors. Samir: If we didn't become family doctors, we would have become monks. Samir: Uh it's we we give ourselves, our our souls to Samir: service and it was almost considered taboo to ask about salaries or or talk about money.
Samir: And I remember in my very liberal Samir: politically liberal program, nobody wanted to talk about salaries, God forbid. Samir: I did, because I was this uh very unshy Samir: uh person had grown up around the world and had loans to pay back. Erik: So wait, you mean you you took a realist view to the whole situation? Samir: Yeah, I suppose I did.
Samir: And that did not make me very popular, but at Samir: The end of the intern year I found out about something strange called concierge medicine. Samir: And I looked it up, I was just it was a bizarre term, and I Googled it, because Google was in at that time, this is two thousand and two. Samir: And I found a company called MDVIP that had just been launched the year prior. Samir: So in my scrubs, I remember I called Samir: MDV IP.
Samir: I was post calls, I was already pretty loopy. Samir: Um and and and a little adrenaline uh, you know, and on coffee and caffeinated and uh Samir: Darren Engelhart picked up the phone and he said, Hi, this is MDVIP. Samir: Can I help you? Samir: And I said, Yeah.
Samir: I'm interested in what concentration medicine is. Samir: And he explained it to me very nicely. Samir: I found out later he was their general counsel and Samir: He says to me, so doctor, how many patients do you have? Samir: I said, yeah, you know, I've got quite a few.
Samir: I've got to finish my rounds later on this morning. Samir: Um Samir: Oh, you work in the hospital too. Samir: What what field? Samir: Oh, family medicine.
Samir: Great, great. Samir: So how many patients do you have on your panel? Samir: I said, yeah, I've got to see about thirty patients this morning. Samir: Okay.
Samir: Well how many patients in your practice? Samir: And after this good half hour chat, he realized that I was just a re a resident and I didn't have my own practice. Samir: And I said, well, I'm just a resident, I'm an intern. Samir: He said, oh, in his home.
Samir: It was funny, his old mood changed. Samir: So well we can't help you then because uh this is how we work and he taught me about how they take an established practice and shrink it to a core panel that'll pay this membership fee. Samir: I said, well, Mr. Samir: Engerhardt can you help me when I graduate?
Samir: I'm going to graduate in two years. Samir: He said, no, no, we don't do that. Samir: And so but I was convinced that with a panel of four or five hundred or six hundred patients, I could spend more time with my patients. Samir: I could spend time talking to them about Samir: their spiritual needs, about their habits, about what made them sick, what made them heal, what made them happy.
Samir: That's what I was looking for as a family doctor. Samir: And I found it in this industry that was bizarre sounding called concierge medicine Samir: I couldn't find a single attorney to help me start a concierge practice after residency. Samir: Uh even made the front page of the local papers when I announced that this was gonna be the future of medicine. Samir: Got in trouble for that by my director actually Samir: You can't say things like that.
Samir: You can't even prescribe antibiotics out of the hospital yet. Samir: Yeah, I know, but so um still have that that that cover story Samir: And I started advertising my new medical practice while I was a second-year resident around the country to see where I would get Samir: the biggest pull. Samir: At this time there was not a single concierge practice at Houston or Chicago. Samir: I ended up in Pebble Beach, California, because that's where my best friend from medical school was going.
Samir: My mother-in-law was happy because I was moving to California finally. Samir: And uh my opening act out of residency was the house physician for Pebble Beach Resorts. Samir: And uh that that's a hard act to follow. Samir: But that was the beginning of my career.
Samir: No claims. Samir: I billed $2,000 an hour at Pebble Beach, got paid in petty cash Samir: And took care of some very famous people uh you would know very easily out of Hollywood and worldwide. Samir: And uh that was the start. Samir: And I realized that I did not want to practice medicine Samir: in that way.
Samir: I day I did the math actually. Samir: If I see twenty-five patients a day, thirty patients a day for twenty-five years. Samir: That means I would have taken care of about 150 to 180,000 patients total in my lifetime Samir: And like the both of you, like every medical student who applies to go to medical school, you don't want to just take care of 150,000 people. Samir: You want to save the world.
Samir: What could I do? Samir: And so it started with concierge medicine, and then it trickled to direct primary care, and then that trickled to medical devices, and that trickled to AI because I wanted to put Samir: experience and my very expensive medical education to tech that could scale to millions and not just 150,000 people. Samir: Nothing wrong with taking care of a town or a smaller population, but I Samir: I started getting more ambitious, I suppose, with what I could do with my skill sets that could be scaled to more people.
Samir: Yeah, it was an interesting end to my residency. Davin: Yeah, no kidding. Davin: Were were you um you know, I think we were in medical school kind of at a similar time, you know, the late nineties Davin: Um and um I remember you know having like a palm pilot or something in my pocket, you know, like do you remember those like the Sure Palm Pilot, Sony Trio had them all. Erik: Hippocrates was the big revelation, right?
Erik: Yes. Davin: Yeah. Davin: So I I'm curious like were you all were you d were you a tech did you gravitate towards tech or or do you are or is tech more of like Davin: part of the scalable solution uh or is it a combination of of both? Samir: When you grow up in emerging markets like I did, so I lived in Papua New Guinea for two and a half years.
Samir: Famous for its head hunters. Samir: Uh we had a house built on pillars to avoid the wildlife below. Samir: I I lived in Jakarta uh for two years. Samir: I lived in Kathmandu for three years.
Samir: Places like that. Samir: Went to international schools everywhere. Samir: Any kind of technology that came from America was cool. Samir: Right?
Samir: You could show everybody your BMX bike because everybody's driving these Samir: old Chinese bicycles, you could show them your Atari 2600 video game and now you were the coolest kid on the block because you had Atari. Samir: Um so I was always into tech, I think Samir: Not so much because uh while uh you're in medical school, you don't have time for tech. Samir: You just uh you you have to read, you have to keep up with your board exams and all that kind of stuff, and take your USMLEs and that's fine.
Samir: Um Samir: I got more into it when I was in Silicon Valley. Samir: So when I was the house physician for Pebble Beach, Samir: you catered to a clientele that would often come down to play golf from Silicon Valley. Samir: Many of them were venture capitalists and successful entrepreneurs, and as you might ask, just to make casual conversation, as you do when you're a family doctor Samir: What do you do for a living? Samir: And I was always interested in who could afford to pay me $2,000 an hour.
Samir: Um and I I got some really interesting replies. Samir: And many of them were entrepreneurs who had done well selling their companies and Samir: going IPO and all of that and I started getting more and more into tech. Samir: MedLion, which was a direct primary care company that I launched Samir: after realizing that I could take the membership model and instead of charging tens of thousands a month, which I did for my concierge practice, I could Samir: Scale that to more people if I charge less every month and just do primary care.
Samir: Medline was the first direct primary care company in California. Samir: Uh we opened an office in Mountain View, Silicon Valley, and that got me quite popular with some of the local VCs who now saw a model that could be scaled, maybe with venture capital. Samir: So I started meeting with Samir: uh a lot of very famous venture capitalists 'cause they were interested to know and and I was this Samir: Schmuck, right? Samir: I I I will I wear a bow tie and a full suit to these venture capital offices.
Samir: They're looking at me like, oh great, here's another doctor who thinks he's gonna change the healthcare world. Samir: And I learned a lot. Samir: Um I was very naive back then Samir: And that's where I started picking up my interest in technology again. Samir: Uh and I I and I never went away.
Samir: Uh so that's that's where I think it started I was always interested in technology, but Samir: That interest was reignited after I saw what technology could do for the world in Silicon Valley. Davin: Well, I think also I mean uh yeah, and you say you were naive, but um, you know, your mind was like Davin: ahead of the curve, right? Davin: I mean, um, you know, direct primary care, what you know, what a great concept. Davin: And, you know, it's really taken off, I think, um, because of the Davin: affordable nature, right, of of those of those memberships.
Davin: So people can have insurance and not feel like they're, you know, what whatever they have to pay for for that for that practice. Davin: I mean, it's pretty fascinating to me that you, you know, you are so far ahead of it for me, you know, I just got into this world, you know, a couple years ago, and and uh and my rationale for not Davin: taking insurance was just listening to Erik uh and some of the later latest frustrations with what the insurance companies were doing to them, right?
Davin: Like Davin: changing the rules, you know, really squeezing them, you know, making it harder and harder to justify alternative treatments. Davin: Um Davin: But, you know, aside from a you know, a few business uh magazines or something that you stumbled across, uh, like where did that come from? Davin: Where where do you think you, you know, were able to figure that out? Davin: at so early in your career.
Samir: I I don't think it has anything to do with me figuring it out. Samir: It was I grew up in a Samir: In an environment where insurance didn't exist when Dottore Fabrizio Valente would come visit our family in Rome Samir: at our house, he didn't bill insurance. Samir: He just stayed and had a cappuccino with us. Samir: Uh we went to his wedding.
Samir: I mean, that's the real family dot thing, right? Samir: It's when Doctor Dixeth and Kat Van Doo, the expat doctor who spoke perfect English and was trained in England Samir: When he would come visit us or we would go to his office, we didn't even talk about insurance. Samir: Dad didn't have health insurance growing up uh or working for the UN in those kinds of countries. Samir: Um Samir: That was one thing that stuck with me is why is it different here?
Samir: And fast forward to concierge medicine that we just discussed. Samir: It was the provision of primary care in exchange for a membership fee Samir: And that changes the dynamic, as you know, from what is typical in a fee for service environment because Samir: If I have a patient I'm diagnosed with hypertension and I put them on, say, Lozar, and I say, okay, Mr. Samir: Smith, why don't we see you back in about a month so I can see how this is working? Samir: If Mr.
Samir: Smith is having a problem paying his bills, Samir: He's not gonna want to pay me for a visit just to know that the medicine is doing its job. Samir: If he's not feeling anything, he's not gonna come in. Samir: If he's having trouble paying his bills. Samir: Uh so and it's not just the monetary cost, right?
Samir: It's the whole act of getting into your car, taking sick time off of work, and coming in. Samir: Concierge medicine changed that entire mindset because you could then communicate with the patient by phone, by video, in other ways, because there was no fee involved anymore per visit. Samir: And Samir: To me that was cool. Samir: Uh I remember when the iPhone came out, I was in Monterey and I had concierge patients texting me and like Samir: you know, like the doctor does.
Samir: Oh, this is not HIPAA compliant. Samir: You know, just y I don't care, Doc. Samir: I just want to get you the information so I don't have to come in. Samir: Like, wow, okay, if somebody worth a gazillion bucks doesn't care, why should I care?
Samir: Uh and so you start thinking differently. Samir: Sure. Samir: And I'll never forget. Samir: Um Samir: Here I am taking care of very wealthy people.
Samir: Uh very I I have at least six billionaires in my panel. Samir: This is Monterey is a very interesting town. Samir: And Samir: The recession hit in 2009. Samir: My wife was a regular doctor, seeing regular patients with insurance and Medicare and so forth.
Samir: And Samir: We had a patient once who called her office her office who couldn't come in because he couldn't afford the self-pay rate. Samir: He had lost his insurance because of the recession. Samir: And I was the one who picked up the phone and I said, you know, so and so you have to come in. Samir: He was the editor of a very big paper there.
Samir: And he said, I I can't. Samir: I can't do it. Samir: I can't pay your $100 self-pay rate Samir: And it dawned on me, like, what am I doing? Samir: I'm taking care of some very wealthy people here.
Samir: Um why can't we create a membership model for the less fortunate folk, the farm workers and salinas who'd lost their jobs? Samir: Uh so the biggest threat to a concierge practice, by the way, is the way you structured the membership fee. Samir: I learned that in residency, because nobody would write me a membership fee. Samir: And they said, Oh, you're providing insurance.
Samir: You can't do that. Samir: I said, No. Samir: If MDVIP, a company that's raised venture capital, has done this, there's gotta be a way Samir: So if the threat is looking like insurance, it's easy for me. Samir: You you take what insurance is defined as and you reverse engineer it back into a membership plan that is not defined as insurance.
Samir: And there's ways to do that, right? Samir: You you you pay Samir: after, not in advance. Samir: You don't charge for things beyond primary care. Samir: There's lots of things you can do.
Samir: And so I did that. Samir: And I knew now how to charge for a membership medical practice without looking like insurance. Samir: Why not apply that principle to simply a smaller fee? Samir: That's it.
Samir: And instead of seeing three or four hundred patients, you would see. Samir: A thousand? Samir: You're still less than the national average, and you'll still make money, probably more money than you would make as as as a employee doctor. Samir: That was the Samir: the spark for Medline and I started doing that and I th let's do it, see where it goes.
Samir: And I started doing well. Samir: And I'm thinking, okay, this is cool. Samir: Then I looked around the country and I saw there was this company called Q Lions out of Washington that Samir: was doing this with Venture Capital and there was Dr. Samir: Brian Forrest, North Carolina.
Samir: I'm like, oh my God, there's other people doing this. Samir: This is cool. Samir: And then we all collectively became known as the the pioneers that did this. Samir: So yeah.
Samir: I I think it was my upbringing Samir: and my unique training that led to this natural progression of what came out to be direct primary care. Samir: I always thought Samir: That society in America was being brainwashed into thinking health care is health insurance Samir: No. Samir: It's still that way today, but when I talk, and I'm sure when you talk, you teach people health insurance is not in the business of health care. Samir: Health insurance is in the business of insurance.
Samir: And they have done a really good job conditioning the public into thinking that it's healthcare. Samir: It is not. Samir: Yeah. Samir: Healthcare is what you and I do in the room when the door closes.
Samir: Uh Samir: So that continued and it's still that way today. Samir: I can't remember the last time I filed an insurance claim. Samir: I'm proud of that. Erik: That's awesome.
Erik: And the irony of it is, is that Erik: In reality, what we're being communicated to you in terms of using insurance for our health care isn't using insurance for health care, it's using insurance for sick care. Erik: And as long as we can maintain you sick, then from a medical business perspective, we can continue to make money because we have something to build the insurance for. Erik: And the inverse of that of in terms of really doing preventative and and true health care Erik: um actually decreases your revenue potential earnings because you are no you the patient's healthy now.
Erik: So they don't have a need to come in and see you. Erik: Therefore, you don't generate revenue from caring for that patient, where the direct primary care and concierge models Erik: make it such that you are partnering with an individual and you are the expert in the room Erik: in terms of how to optimize their health. Erik: So they want to go on this journey with you and are willing to pay you money to do to help you as their mentor, their guide, their their physician, their healer.
Erik: um, because you're actually helping them from a healthcare perspective than a sick care perspective. Erik: And I'll never forget I had a a a friend of mine who was a physician not too far from where you were and he was Erik: Uh he was also taking care of some of the players on the Sacramento Kings. Erik: And he calls me up one day because he he didn't know about some of the third-party functional medicine testing. Erik: He says, hey, this Erik: This player wants to get this gut health test.
Erik: Um, you know, but it but he wants to know if it's if his insurance will cover it. Erik: And and I just thought, I was like, you've gotta be kidding me. Erik: Like this is maybe Erik: a two or three hundred dollar test and he wants to know if his insurance covers this is an NBA player. Erik: I I mean so to your point Erik: that our society thinks that I need insurance in order to get health care Erik: Um it was just it that that really that was the a bit of an epiphany for me to realize, okay, here's somebody with significant financial means, and yet a simple Erik: Relatively inexpensive test, he's worried about whether his insurance will pay it or not in determin in determining whether or not he's gonna get the test or not.
Erik: That was mind-blowing. Erik: That's interesting. Samir: I think I and I've had a lot of time to think like I'm sure you both have had healthcare versus sick care. Samir: I don't think it's entirely the system's fault either.
Samir: The system's operating exactly as it was designed. Samir: Uh it's a health care it's a health insurance system. Samir: It's not a health care system, in my opinion. Samir: I digress.
Samir: Um, we all have friends who are physicians who decided to go become ICU docs uh or surgeons. Samir: And I think there's a certain mindset with that. Samir: They want to be the ones who intervene when things are really bad. Samir: We need them.
Samir: When my dad was in the ICU after his heart attack. Samir: Uh he needed the CT surgeon to operate and do the bypass. Samir: When he was in the ICU after losing his legs and his hands to gangrite, uh he needed the ICU doctors there. Samir: He was at his worst Samir: And I say prayers for his doctors every day who saved his life, who helped him.
Samir: But they went into those fields because they wanted to be there when the patient was at their worst. Samir: That's their calling. Samir: We're a little different. Samir: We're family doctors.
Samir: We know and we promote. Samir: Prevention. Samir: The healthy lifestyle. Samir: The whole body, mind, soul being treated, uh, being strengthened Samir: And I also believe that people in general don't view medicine as a favorable Samir: Necessity.
Samir: It's just it do I have to go to the doctor's office? Samir: Our waiting rooms are full of people who are sick. Samir: Dying? Samir: They're in pain?
Samir: These are all negative traits. Samir: Who wants to be part of that? Samir: Injections since you're a kid. Samir: Nobody wants to go to the doc's office.
Samir: First thing my nieces say is am I gonna get a shot? Samir: I'm like, no, don't worry, you're not gonna get a shot. Samir: I was asked that when I was a kid. Samir: It was associated with pain from the very beginning.
Samir: And so why why would you want to go there? Samir: Uh forget the insurance part, forget so sick care has become this thing where people only will seek services when they're sick because if they're feeling fine and not feeling pain Samir: They're gonna ignore it. Samir: It's why hypertension is the silent killer. Samir: Right.
Samir: I I wish God or whoever you believe in would have put pain receptors in place for hypertension because then everybody would be coming in for hypertension Samir: and and prevent strokes that way, but because people only come in when they're feeling bad. Samir: Um I think healthcare Samir: is different from medical care and root cause medicine, functional medicine, whole body approaches, holistic approaches. Samir: have to do more with health care uh to prevent the need for medical care, if you will, and Samir: There is an entire shift thanks to doctors like yourself who have put a spotlight on functional medicine, root-cause medicine, where people I believe now are getting smarter about Samir: longevity, about health care, about living meaningfully.
Samir: Uh in good health. Samir: It's not about just lifespan. Samir: It's about health span. Samir: And that is good for prevention, I believe.
Samir: And our roles will change as Samir: People get more and more aware of these things. Samir: Healthcare education was usually guarded by us. Samir: Paternalism has always been there in medicine. Samir: It's starting to shed itself now.
Samir: But now people can go to Google, even though 70% I think the statistics are regret going to Google because they are all gonna Samir: have something scary. Samir: Now it's AI, which I can get into as a little bit. Samir: But I believe that the infrastructure has never been the only problem. Samir: It's been Samir: A lack of distribution of healthcare expertise.
Samir: People who know, after reading about it, that Samir: Putting too much salt can eventually kill them earlier in life, will probably think twice now about salt. Samir: It's education. Samir: We get trained. Samir: We have no excuse.
Samir: That's what people pay to see us for, but I I think if you were to educate more and more people Samir: then they would be healthier. Samir: Uh yeah, I can go on and on about that, but those are some of my thoughts on healthcare versus sick care. Davin: Well I think hopefully that leads us into this next phase that we'll hear about, um which I I think um you know your new company is probably um attempting to solve. Davin: I Davin: I do think that um, you know, there's people talk about like I try to avoid the doctor.
Davin: I've heard people say that, right? Davin: And it's to your point, right? Davin: It's because Davin: usually people go to the doctor, it's associated with something's wrong. Davin: Like, you know, they they have a symptom or they're uh or you know, or they're worried that they have something and so they if they can avoid the doctor, that means they're healthy, right?
Davin: And so I I do think that Davin: Um, you know, this narrative is changing, thankfully. Davin: That, you know, this idea that there are things you can do to Davin: give you more energy to to help you feel better, to be around longer to enjoy your, you know, kids and grandkids, right? Davin: So there's Davin: It's sort of it's outcome based a little bit more, right? Davin: Of people are are feeling empowered to say, hey, I need a a coach in a in a way, right?
Davin: Like if you think about any other aspect of our lives, Davin: You know, we turn to mentors, we turn to coaches, we turn to people who can help us become the best version of whatever that is that that we're trying to become. Davin: And so I I love that medicine feels like um there's a little bit of a shift, maybe not across the board, but we're at least certainly people with means and now Davin: Even those with less in the direct primary care model can say, hey, I'm gonna seek out somebody to help me become even healthier or to have more energy, to live longer.
Davin: Um, and I think it's a s in an exciting time. Samir: There's been a cultural shift. Samir: I've been a physician since two thousand. Samir: And I've seen that shift, like I'm sure you both have over the last 10-15 years.
Samir: It's in the way doctors are perceived, it's in the way vaccinations are perceived, it's in the way medicines are chemicals and there's lifestyle and so forth. Samir: I I think there are many reasons for that. Samir: Social media is a big one. Samir: Social media crosses borders very easily.
Samir: People get to see how Samir: their counterparts are doing in Denmark or in India, and so forth. Samir: I think patriotism, which is important Samir: Is contradicted by better longevity numbers in other countries like Japan, Middle East, Switzerland. Samir: Again, social media plays a part. Samir: The globalization of humanity with travel, which has increased now, uh again, because of social media.
Samir: I keep coming back to social media and realizing that, but I think it's Samir: It it's the it's an equalizing field. Samir: People start to compare themselves everywhere else now. Samir: Not studies that you and I would read about where people live longer than in Japan, but Samir: regular teenagers and and college students are seeing out people in other countries. Samir: I read a study yesterday, it was just published in January that Samir: Colon cancer now is becoming the number one cause of cancer in people l younger than fifty.
Samir: That was unheard of when I was in medical school. Samir: Why is that? Samir: Uh Samir: So you you put all this together, and I think now people are actually interested. Samir: What can I do now to live longer?
Samir: Uh why is America Samir: horrible with this infant mortality rate when we have the best tech in the world. Samir: What why is our lifespan shorter than say a Japanese person's? Samir: And they're starting to really wonder and ask good questions about is it in the water? Samir: Literally, is it the minerals?
Samir: Is it Samir: You know, why do I do I not feel bloated when I have a pizza and pasta in Italy versus here? Samir: What chemicals are there? Samir: Why so and so die banned in Europe and not here? Samir: And then you start realizing Samir: Again, it's all a business.
Samir: Um it's one of the downfalls of a capitalistic society is you start consuming things that help companies make profit. Samir: So I can get into that. Samir: But I I think to go back to the subject at hand, people are getting Samir: more aware that there are things they can do now, earlier, to prevent disease. Samir: They look at their own parents.
Samir: They many Samir: Newer generations are living with their parents because the economy is now such where they can't afford their own homes and their parents living. Samir: My dad lives with me as well. Samir: And they're seeing their parents get sick and what happens. Samir: My mom just died of cancer a few months ago.
Samir: I was witness to that. Samir: And then you naturally start thinking about yourself. Samir: Okay, well, I'm wired the same way. Samir: What's gonna happen to me now?
Samir: What can I do to prevent this or that Samir: And I'm talking about regular people. Samir: So I think and then of course there's the information superhighway like Google and the internet. Samir: You put all that together and you have this perfect storm of Samir: People now wanting to take charge of their own health. Samir: And I think it's part of the reason why we're seeing this rapid rise in healthcare consumerism a lot.
Samir: Now you have AI. Samir: So Erik: One of the things we're doing, uh real quick before you get into that, I think just yeah interjecting piggybacking on that a little bit, I think COVID also Erik: played a big role in this shift, right? Erik: Because here we had a circumstance where for the first time Erik: really created some significant doubt in the medical experts, right? Erik: In terms of Erik: Are they are they really guiding us down the right road?
Erik: Um, is this really you know, and again, to your point Erik: people were hearing and seeing what was going on in other countries in terms of how they were using um you know the medicines that should not be named Erik: In in terms of prevention, right? Erik: Um, you know, ivermectin and and and others that were were used to help treat and prevent Erik: poor outcomes. Erik: And we were seeing that they were having much better outcomes than what we were having in the United States.
Erik: And and that information, which would have been kind of kept from us twenty years ago. Erik: Now, because I mean it's there's still this this mindset in the US. Erik: If it's not if a study isn't done in the US, it's not worth anything. Erik: Right?
Erik: But now as a population Erik: You know, patients don't care. Erik: If it's happening better somewhere else, it doesn't matter if it's India or Jakarta or Erik: You know. Erik: Canada even, right? Erik: I mean they it's like we if it's if if if I'm hearing somebody's getting healthier Erik: than I am here, then I'm now questioning the approach that's being given to me.
Erik: And so I think there was this huge shift Erik: that now has started to create that. Erik: And now with with the increase in technology information, right, the ability of AI to help Erik: Assess all of that information and collate it into these responses. Erik: I think people are now for the first time Erik: really being choosy about where they get information. Samir: Absolutely.
Samir: Though I think uh Samir: There is so much information out there that there are those who are unqualified, frankly, who will draw their own conclusions based on experiences and stories. Samir: And and that gets put out. Samir: Misinformation, I think we call it. Samir: That can also be uh dangerous.
Samir: Yep. Samir: Um but at the same time Samir: There are medical standards and authorities globally that agree on a consensus view of a certain medication or a treatment. Samir: But I I think it's also a reflection of people just simply wanting to get better. Samir: Yeah.
Samir: Uh we can't blame them for trying an influencer's recommendation for a certain peptide that may not be available in the US Samir: Uh do they have that right to try it? Samir: I I think they do. Samir: I'm I'm for freedom of choice, however. Samir: I think they should be well informed.
Samir: It's the same reason we offer informed consent to right patients for any major procedure Samir: Um socially speaking, that informed consent is still questionable, I believe. Samir: But Samir: Yeah, it's it's an interesting world we live in though, very different from where we were. Samir: I think very different from where we're about to become with AI. Erik: Yeah, so so how do you think AI then is going to help Erik: maybe bridge that gap a little bit, help um physicians be better about utilizing um Erik: their book knowledge and their experience knowledge with the ability to coalesce data and information and patterns very quickly.
Erik: How how do you how do you see all of that coming together? Erik: I mean, I had a patient who I was meeting with on Wednesday who he's like Erik: I I'm sitting there and I'm asking m this doctor the question and he literally turns and says, Let me ask ChatGTP. Erik: I'm like, what the heck? Erik: I can ask Chat GPT.
Erik: Like if you're gonna do it, at least hide it from me, right Erik: I ha I don't want to know that you're asking chat something that I could be asking chat. Erik: I'm not here because I want chat's opinion. Erik: I'm here because I want your opinion. Erik: If you don't know, just tell me you don't know and I'll go somewhere else Erik: But, you know, it was I thought it was an interesting perspective from a patient standpoint Erik: Um and I think one of the biggest fears besides uh having a malpractice suit for a physician is not knowing the answer to something.
Erik: Right. Erik: I mean I think if you Erik: You want to really back a physician into a corner where they're going to come out with their, you know, their hands up ready to fight is when you challenge their knowledge. Erik: You know, like I, you know, I'm Erik: I know more than you about a particular topic, or you ask them a question, they don't know the answer. Erik: Doctors often will not test for particular labs because they don't know what to do with the results.
Erik: And that makes us feel very uncomfortable. Erik: So it how how are you like looking at that problem? Erik: And I know I know this is something near and dear to your heart. Erik: How what what are some of the solutions that you guys are now coming up with?
Samir: When my mother got cancer fifteen years ago, well there was a part of her life where she lived with me. Samir: Uh that was when my father also had his heart attack and lost his legs and his hands. Samir: So they both were living with me for some time. Samir: We don't have any kids.
Samir: But I'm a doctor, my wife's a family doctor, and it just made sense for the parents to be with us because we would always be at their beck and call. Samir: We could see if their medicines were okay and Samir: Help them with their arrangements with specialists and prior authors and whatever they need it. Samir: And I got thinking, we can do this because we're tech savvy. Samir: We have the medical knowledge.
Samir: My parents have literally us at their fingertips. Samir: What do regular people do? Samir: They don't have Samir: somebody in the house, 24-7, who could answer questions for them. Samir: When my father would have heartburn, he'd be worried that it's another heart attack.
Samir: He could immediately text me and say, hey, am I okay? Samir: And I go say, Yeah, Dad, you're fine. Samir: Uh but what do regular people do? Samir: And that really bugged me.
Samir: That was while I was building another tech company called Medwand, which was a Samir: That's a whole different story. Samir: That was a computer mouse that I stuffed medical diagnostics into because I saw a big gap in telemedicine that was growing, which was the lack of physical examinations during video appointments, and I wanted to solve for that, which we did Samir: The company's doing well now and uh we got FDE clearance, which is a whole different thing, and it's it's off to the races for that company.
Samir: But I wanted to see if I could democratize healthcare knowledge that I had that could be accessible by everyone. Samir: And around this time is when AI started to creep in. Samir: So I have a lot of thoughts about AI, and I've been thinking about it nonstop since that time. Samir: But one of my beliefs, going back to that story you gave me, Erik, about your patient, is that Samir: AI will change medical practice forever.
Samir: I truly believe that. Samir: I've seen up and just close what Samir: AI can do. Samir: I keep up with everything because we're building stuff and we'll get into that in a minute. Samir: But AI is not the same AI as it was two years ago, but she made mistakes, hallucinations, and stuff.
Samir: If you pay for a model Samir: With anthropic or open AI, it's mind-blowing the amount of knowledge that it can hold, but also now it's getting into judgment and reasoning and taste. Samir: It's crazy and I believe that the physicians now who turn to open evidence or other AI models Samir: Aren't doing a disservice to patients. Samir: What they're doing is they're tapping into this vast medical database that will remind them Samir: what they need to know to help best take care of the patient.
Samir: It's not that the doctor doesn't know. Samir: It's also about knowing what to ask the AI model. Samir: to get the best answer. Samir: Patients don't know what to ask.
Samir: The doctor will know better what to ask based on the context with what the patient approached them with. Samir: And so Samir: That patient shouldn't be unhappy about that because we simply as doctors can't keep up with the amount of medical knowledge that gets doubled every f I think every few months now. Samir: When you and I practiced medicine even twenty years ago, it was very different than it is now. Samir: Our great great grandparents back then, GPs, did the surgeries, they did the deliveries, they did everything.
Samir: That's what they call the general practitioners. Samir: But as medical knowledge became more advanced, we needed to branch off into specialties because we just don't know everything about cardiologists. Samir: We we just can't operate and see patients for a cold at the same time anymore. Samir: And so we've already been seeing this this this branching off of medicine in different places because of how vast the knowledge is getting.
Samir: And AI now is basically putting all that together. Samir: And I think doctors should use AI now to help them with their decision making uh for patients. Samir: Now that said, I believe that we are on Samir: I I don't think doctors realize how different their lives are going to become in the next 10 years. Samir: And here's what I mean by that.
Samir: And I don't mean to put any fear or alarm Samir: But I believe that anything cerebral, any role that is cerebral in nature, whether it's analysts or anything where you have to think Samir: Is going to be done by AI. Samir: And that doesn't mean that our jobs as primature doctors will go away. Samir: What it means is that our roles may change. Samir: If Samir: A patient walks in and says, it hurts when I pee.
Samir: And it burns and I'm going more often. Samir: They themselves will tell you they probably have a UTI, either from experience or Googling their symptoms. Samir: It doesn't take Samir: A doctor has been trained with seven years of medical education to tell them that. Samir: They know.
Samir: What they need the doctor for is the prescription Samir: And that is where things may not change right now, but we've just seen a pilot now that's happening in Utah with one of our competitors where Samir: AI will even refill your medications. Samir: It's supervised in the beginning with a human in the loop, but that will then be left alone to just AI doing it if the pilot works out. Samir: That will probably end up becoming a framework for other Samir: states in the future and in countries where they don't care about these types of things like Saudi Arabia or Dubai or China Samir: You're gonna start seeing this happen much faster.
Samir: There's a lot less regulation in those countries. Samir: We're willing to take that risk if it means helping more people. Samir: They also farm people sometimes unknowingly or naively, but that's a different thing. Samir: So I think AI is gonna change the role of doctors.
Samir: Those roles where we have to do something physical with the patient. Samir: Surgeries, uh shots, th those things are not gonna go anywhere. Samir: This place is not gonna go anywhere. Samir: But I I think a lot of the cerebral things are gonna change.
Samir: So what we're building Samir: And we're not trying to replace doctors. Samir: I just want to say that up front. Samir: Uh we're we're not we're not doing that. Samir: Um what we're doing is basically Samir: We're building an AI that gives millions, if not billions, of people access to medical reasoning, to healthcare information.
Samir: Uh that's accurate. Samir: So we have created a an AI agent named Astrid. Samir: Astrid actually stands for a system true, reinforced infinite physicians, infinite doctors is what it is. Samir: And our goal is to have Astrid become Samir: The entity that I was for my parents when they were sick.
Samir: A place where patients can easily access medical information that's vetted, that doesn't hallucinate Samir: that will give them sources and tell them if a fever for a two-year-old in the middle of the night is something to worry about or not. Samir: AI hallucinates in every domain. Samir: It's it does that, it's getting stronger. Samir: But in most domains, the cost is an apology, but in healthcare, that could cost you your life.
Samir: So we have to make sure that Samir: The guardrails are fantastic. Samir: Yeah. Samir: That the instructions are great. Samir: I actually designed the prompting system for Astrid as a doctor.
Samir: I wanted to see if I could get it to Samir: Ask sequential questions, think in systems, not in question and answer formats, to acknowledge that it does not know the answer to something. Samir: uh to tell you where to go for that answer to to know when to escalate that care to a physician or to a lab or to imaging. Samir: So we're working on all that. Samir: It's gonna be a work in progress because AI keeps changing.
Samir: But our goal is simply this. Samir: We're trying to build a tool. Samir: for billions of people that gives them access through their phone to the best healthcare information so they can make better decisions and uh Samir: uh not get sicker. Samir: That's what we're building with with Astrid.
Samir: And we're starting with the English language. Samir: It's going to be offloaded to the world. Samir: We're doing it globally from day one, because you can. Samir: You know, in traditional healthcare unit economics Samir: You're talking about hiring doctors and building bricks and mortar clinics.
Samir: But with AI, the only cost you really have to worry about is your compute costs. Samir: So the margin s to take care of the millionth patient is about the same as the first patient, because you don't have physical infrastructure. Samir: Uh you can scale borders much faster. Samir: Yeah, granted you have to Samir: Abide by the regulations of every jurisdiction.
Samir: Europe has its own. Samir: America with HIPAA has its own. Samir: He is to build that in from day one, as doctors are taught. Samir: to value privacy, to value security, to value accuracy.
Samir: And you build something accordingly. Samir: Today you have Samir: What I consider horizontal AI companies slapping on the healthcare feature because healthcare is a four trillion dollar industry they want to tap into. Samir: We're the opposite. Samir: We're a healthcare company building AI from day one.
Samir: And I think there's a difference there. Samir: That's what we're doing and we're we're pretty excited about it. Samir: Uh it's already in beta. Samir: I should probably get both of you uh on the list to just play around with it.
Samir: Phase one is education and information where you can just ask questions back and forth. Samir: uh about symptoms, about health care, about nutrition. Samir: Uh there's a whole session in there for nutrition, for movement, for Samir: sleep for stress management because that's the way I believe as a family doctor should point to anyone anywhere in the world, regardless of where you live. Samir: Phase T will be integration, where you'll be able to pull up your upload your records, labs, wearable data, and it'll use that information to Samir: give you information about what could happen, what should have happened, etc.
Samir: And then lastly, uh I want to link it up with healthcare services throughout the world where you can get it escalated uh to doctors, nurses. Samir: physicians, a labs, all that. Samir: So that's happening uh later. Samir: So it's a big project, but I think it's gonna be my life's work.
Samir: I'm tired of startups. Samir: Uh I used to want to do this now and just get old with this. Samir: So Samir: I don't have any kids. Samir: I don't have any kids.
Samir: I don't know who's gonna take care of me like I took care of mom and dad? Samir: Probably no one. Samir: So I need Astrid to take care of me when I'm 85 years old and something happens. Davin: That's right.
Davin: You're it's your uh it's like one of those movies, iRobot or something where the you know they have the you're creating your own uh caregiver. Davin: I love it. Davin: Um Davin: Now it it's what an aspirational goal. Davin: I I think uh democratizing that kind of healthcare information and advice.
Davin: in a thoughtful way is is really really amazing. Davin: Um I'm a big fan of AI. Davin: You know, I think being new to functional and integrative medicine Davin: Um, you know, I I think my ability to to to you you know use that information quicker in advance, uh my Davin: sort of transition in into the space uh has been facilitated by AI for sure, you know. Davin: And uh um what's what's been really interesting is seeing Davin: you know, people um respond, um, you know, because um at the end of the day, um Davin: that human side of it, right?
Davin: Of of feeling like somebody has validated, you know, and heard them and has spent the time to care. Davin: uh to invest in trying to figure out what what is going on with them. Davin: Um I I don't think they they care, you know, that some of that information came Davin: you know, with the help of AI, right? Davin: As long as I as they feel like I'm getting it right and it's gonna help 'em, right?
Davin: Um, and that I care. Davin: You know, there's that element and uh Davin: It will be interesting to see how how people um y you know, w without that human piece, you know. Davin: Um Davin: how how that might unfold or or how people and but that's a that's sort of across the board, not just in medicine, right? Davin: As we sort of interact with technology in in ways that we Davin: didn't expect probably a few decades ago.
Davin: Um it'll be interesting to see how we evolve as a species and interact with with uh technology. Samir: I have a lot of love, a lot of respect, a lot of deep admiration. Samir: for doctors. Samir: Uh I am one, my wife is one.
Samir: Just but technology waits for no one Samir: And if you think about the reason we went into healthcare, what what was the end goal here? Samir: It's not to simply just have a career, which was part of the goal. Samir: Right. Samir: It was so that humanity could become healthier.
Samir: Whether it was in a small town in South Dakota or a big city in India, it doesn't matter. Samir: It's human beings. Samir: Trying to get better, trying to live longer, trying to have a better quality of life. Samir: And I believe Samir: It's a little sad that people now feel the need to have to turn to Google, to AI, to get Samir: basic health care information.
Samir: I think it's because they're desperate. Samir: Yep. Samir: They are willing to forgo privacy Samir: HIPAA, any of the, even hallucinations, if it means they can get somewhat of Samir: just direction on what to do when they're desperate because either healthcare is too expensive, it's not affordable, it's too far away Samir: They don't understand. Samir: So I think that's where AI can really help bridge that gap.
Samir: Our roles will change as doctors, but we won't become extinct. Samir: It'll just be a different we'll be a we'll practice differently. Davin: Yeah. Samir: That's okay.
Davin: Well, and I and I think it's it's not just the AI piece, right? Davin: Because um to your point of just that convenience and having an answer when you need it. Davin: Um, you know, just as an example, last night, you know, one of my patients, they sent me a picture of their, you know, child who had a cut. Davin: And they're like, ER or or not, you know, like that that one but I need to know, you know.
Davin: And Davin: to to get an answer like right away, like you know, like no one wants to go spend two hours in the ER, right? Davin: Um maybe four, who knows, depending on how busy it is, right? Davin: So Davin: the confidence that you're making the right decision eases your mind as a as a person, as a parent. Davin: Um, and I think to your point, you know, your experience with your parents at home, getting quick answers.
Davin: was the difference between maybe an another s you know, ER visit, unnecessary ER visit, uh and or just Davin: that peace of mind, you know, that people deserve. Davin: So I yeah, I think it's really interesting. Samir: It's interesting and it's tricky because we I I just learned of a new Samir: AI doctor startup that was launched out of San Francisco yesterday. Samir: Uh medical students who haven't even yet graduated yet decided to go all in.
Samir: Good for them for having the courage, but I I think unfortunately would lack Samir: The experience of being a physician that all three of us on the call here know is so important. Samir: Judgment calls Samir: Nutrition, the way you talk to patients, even, how to get that rapport. Samir: All of us develop our own way. Samir: And you don't get that in medical school.
Samir: You get it through years of experience and seeing patients and holding their hands and Samir: all of that. Samir: There are other technophiles who are trying to create the AI doctor of the future. Samir: And Samir: I've always said something just because you can do something doesn't mean you should. Samir: Uh I believe that Samir: AI in healthcare needs to be created by doctors, by nurses, by clinicians who understands the Samir: what it la what it's like to be on both sides of the exam table.
Erik: Yeah. Samir: Um they approach from a strictly consumer perspective because of something that they may have experienced at Samir: they weren't in agreement with or they were wronged or they want to improve in the system. Samir: Uh but I truly believe that healthcare is one of those industries where disruption needs to come from within. Samir: All three of us can become patients, but our patients can't become doctors.
Samir: And unless we know how to tackle Samir: and approach innovative healthcare models or technologies from both the clinician's perspective and the consumer's perspective Samir: They're not gonna do us well. Samir: They're not gonna be sustainable. Samir: So we're very excited about our launch. Samir: It's gonna start out in English, um, and then we're doing Spanish, and then we're doing French and then Arabic in that order, and then Hindi Samir: Um but it's voice enabled, so you can speak to it because there's a lot of people in the world who don't speak English and many whom are illiterate.
Samir: They can't they don't know how to text. Samir: They can't read or write, so I don't need to speak to them. Samir: So we've done that. Samir: And uh yeah, I'm a little nervous about how viral it gets because it's free initially.
Samir: It's gonna be free. Samir: So it can spread quickly, uh, like ChatGPT, but vetted. Samir: And there'll there'll be paid plans later for special features and Samir: And things like that. Samir: But uh yeah, it's it keeps me uh excited.
Samir: I can't sleep. Samir: I'm so excited thinking that maybe I'll make a difference to somewhere in some village, somewhere in the world who Samir: we'll get that information need about whether or not to go to the doctor a hundred miles away or not. Davin: Amazing. Davin: I love it.
Davin: You know, I think um Davin: wherever people stand sort of morally or from a philosophical standpoint around like, you know, how we interact with technology, I think, Davin: For those of us that have kids, you know, it comes up, you know, should should you know when they were little, should they have a phone in their hands? Davin: You know, when when should you first let them have a phone? Davin: And I I think this is a similar discussion in that, you know, my philosophy, and I'm not saying anyone else's is wrong.
Davin: Um, but Davin: My thought was this is the world they're growing up in and you know, you could just avoid it or you could teach them how to Davin: be at peace with with it, right? Davin: Soon the sooner they learn how to sort of live with it and understand it and have boundaries and whatnot. Davin: And I think in medicine, you know, there's doctors that are almost like Davin: trying to avoid it and and I think that's for me personally I think that's the wrong approach. Davin: I think what you're doing makes a lot of sense.
Davin: It's the future Davin: And the sooner we learn to coexist in a in the most meaningful way for patients, I think the better off we'll be. Samir: I totally agree. Samir: I I think Samir: our doctor friends aren't going to have a choice. Samir: And it's it's here because markets are not dictated in health care by what the doctors think.
Samir: They're dictated by Samir: that what the patients want, what the patients think. Samir: We're seeing that with self-ordering of labs and I want this and I want that. Samir: And again, the consumerism of healthcare coming full circle. Samir: But uh it's an exciting world and you know, a lot of us in medical school those in medical school today, they don't Samir: They don't have the time to think about technology or business.
Samir: And I think they should be thinking about both. Samir: I also believe that you're gonna see a lot more physicians Samir: Uh straying away from traditional healthcare to other things, academia, technology, pharma, because doctors can be useful in many ways. Samir: The creation of new technologies is a big one. Samir: Why can't we scale our knowledge to millions of people?
Samir: We should be able to do that. Samir: We all went to school. Samir: to serve mankind. Samir: And so why not take care of millions?
Samir: Why only a hundred and fifty thousand if you have that capability? Samir: So it's quite fascinating. Samir: I I we have an intern at AstroDoc who Samir: uh had this debate with me about do I go to medical school, do I go to business school, do I become an engineer? Samir: And I think I've confused him more than anything because we do all three things, that Astrodoc, Burguide.
Samir: Um but I still think there is a very valuable role for the physician. Samir: And he'll be going to medical school. Samir: And uh I just told him, combine that. Samir: with business elements or technology elvis because then you're taking care of yourself and many other people.
Erik: Yeah, I love that. Erik: And it's, you know, it's been really interesting conversation we've had today, right? Erik: I mean, if we've been able to really see Erik: How your life journey has really shaped you and prepared you for where you are today Erik: and for your capability as well as your ingenuity, as well as your perspective in terms of how to put together a system that is going to be helpful for the entire world. Erik: Um, not just for those few that you can see at Pebble Beach, right?
Erik: Uh it was y this this launched you into Erik: the the possibilities. Erik: But each one of those stepping stones was critical for your development and your perspective to get to where you are today. Erik: And I I totally agree with you. Erik: And I think the one thing that we we have Erik: talked about with other guests on this sh on this podcast and and what you've hinted at to some extent and that is the the part that's never gonna really be replaced by AI is the connection, the human connection.
Erik: that that we all crave, that we all strive for, that actually makes us stronger and better. Erik: And as physicians Erik: I think part of the gift that we've been given or and that we foster and develop is this ability to connect with our patients in a way that is inspiring. Erik: the way that helps them want to have more of a transformation for health in their lives. Erik: And I think that's why they come back.
Erik: Um, you know, it's why they will maybe sacrifice uh to come to pay whatever it is necessary, even when they don't have the means. Erik: because they feel that connection and they they crave it and they want to be able to know that, all right, the information that I'm getting off of Google or to AI or wherever Erik: You can help me make sense of it and you can help guide me in my journey and moving forward. Erik: So Erik: I I I really, really have enjoyed this conversation with you today.
Erik: And you know, normally we end with uh okay, well what do you see the future of medicine to our our patient? Erik: You've kind of already given us that Erik: And so so maybe maybe we'll give you a different question today. Erik: Maybe we'll ask you, you know, how how do you see Erik: the role, you know, I we talked about the roles changing, but how how do you see the the role of the Erik: Maybe role isn't the right way. Erik: The partnership between a physician and a patient moving forward with Erik: All of these resources that now we are having developed and are going to be accessible to each of us as as time goes on in the next five to ten years.
Samir: I think with improved technology, a better equilibrium of healthcare knowledge, AI Samir: Doctors are going to end up becoming either coaches or cheerleaders Samir: Patients are gonna start wanting to take care of themselves. Samir: Thank goodness. Samir: Yep. Samir: They're finally getting it.
Samir: What you do at 20 matters when you're 80. Samir: I'm really happy about that. Samir: I hope my my nieces will will grow up like that with good habits that will help them when they're older so they're living longer. Samir: But for us as doctors, that rule will change.
Samir: We're not going to become the ones who have to educate them as much as we used to. Samir: Patients are going to come in armed with knowledge. Samir: And it's new right now, but they shouldn't chastise us if we don't have that same knowledge. Samir: We can also look at our AI tools and get the same knowledge very quickly.
Samir: If they're doing things that are helping themselves and things are going well, we become their cheerleaders Samir: Great job. Samir: Keep going. Samir: I would add this or that or subtract that, but Yeah. Samir: Because they don't know how they're doing Samir: They're coming to you with a plan, you can compare them against your other patients and you can tell them that this works.
Samir: You become a returning leader. Samir: If they're not doing things well, Samir: For some reason things aren't working out. Samir: We are human. Samir: Go work out, do cardio and resistance training four times a week.
Samir: Uh can't because I hurt my ankle. Samir: I just wish I could, but now I'm getting sedentary. Samir: Then they need a coach. Samir: And they already are armed with the knowledge.
Samir: They know what to do. Samir: And then we end up coaching them with what to do, what not to do, what to eat, what not to eat. Samir: So I think Samir: In the end, our primary care role is going to be delegated to coaching or cheerleading, which is kind of what we have always been. Samir: You add to that education and Samir: That's what's really taking that 10-minute visit and drawn it out to 15, but that's how we believe that's how I believe we're going to become.
Samir: Isolation is a torture mechanism. Samir: People need human touch to to be human. Samir: And they will always crave that. Samir: I don't think our f industry is gonna die out where Samir: People will seek out a different touch, maybe through psychologists or social workers, maybe an entire new field that I haven't even thought of of yet will come into play at some point in the future.
Samir: But human beings need contact. Samir: They need to be built to be around people. Samir: I would have much rather have this podcast with both of you in person. Samir: Then on video that was possible.
Samir: It's just the way we are as people. Samir: That'll never change. Samir: Um it's cool to see technology and AI and so forth. Samir: Make lives easier for people, but at the end of the day we are all human and that will never change.
Erik: I love it. Erik: That's very well said. Erik: That's great. Erik: Um well if people want to know more and learn more about uh Dr.
Erik: Qamar and and Astrid, where where should they go? Samir: Yeah, so I know most doctors don't like LinkedIn, but I'm very active on LinkedIn. Samir: I would recommend, by the way, getting on LinkedIn to stay aware of all these latest developments. Samir: Um, but um Samir: Yeah, Astrodoc is like it sounds, A-S-T-R-O-D-O-C dot com.
Samir: And uh just go on there and follow what we're doing and Erik: Yeah. Erik: That's awesome. Erik: Well thanks. Erik: Thanks for taking the time uh to be on our podcast today.
Erik: I think it's been a wonderful, valuable uh conversation. Erik: I know I've I've enjoyed it and I I'm sure Davin has as well. Erik: Um I can tell just Erik: by the smile on his face, which is great. Erik: So thank you very much for taking the time and and we look forward to seeing how things evolve.
Erik: I'd love that. Erik: This is fun. Erik: Thank you very much, Erik and Dev. Erik: Yep, you're welcome.
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