clinicians.dev

clinicians.dev

A community of clinical experts super-powered with skills in agentic engineering. Our roots are in coding and clinical medicine. We know how to create and supervise LLMs writing Python, SQL, R, JS, HTML. We love startups, regs, policy, UI/UX, data viz, project management, informatics. We want to create the medicine of the next 100 years.

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today · the wire

The Wire

What you'll be asked today — and what to say back. A couple that caught my eye this morning; the rest are on the wire.

Our scribe pilot worked. So why is the medical cost trend the worst it has been in seventeen years?

Fierce Healthcare · Aug 2026

PwC surveyed actuaries at 27 health plans covering more than 100 million members and put commercial medical cost trend at 9 percent for 2027 — the sharpest jump in roughly seventeen years, with nearly 70 percent of those plans naming provider-side AI documentation and coding tools among their top three cost drivers. The mechanism isn't fraud. AI-enabled documentation captures more specificity and more reimbursable severity per encounter without a matching increase in care intensity — a UCSF analysis found AI adoption correlated with more billing units per encounter and no increase in denials. The extra billing sticks, which is the tool working exactly as sold, viewed from the other side of the table. Freed physician time converts into more visits, more tests, more referrals, and administrative savings get absorbed as margin rather than passed through as price. The one exception in the data is capitation, where recovered capacity has nowhere profitable to go except prevention — which tells you where the actual fix lives, and it isn't in the software.

80/20Forget the accuracy benchmarks for a second. Ask one question about every clinical AI tool in your building: does it increase what you bill, decrease what you spend, or neither? Almost everything deployed in American healthcare right now is in the first bucket, and the plans have finally started pricing it.

Ezekiel Emanuel and two Khoslas argued in JAMA that putting a physician back in the loop makes the care worse.

JAMA · Aug 17, 2026

The claim is that on five cognitive tasks — eliciting history, building a differential, ordering tests, prescribing to guideline, managing chronic disease — models already match or beat licensed physicians, and that mandating a human in the loop past that point degrades rather than protects care. The numbers are real: ChatGPT o3 ranked the correct diagnosis first in 60 percent of 377 complex cases versus 15.9 percent for twenty internal medicine physicians on a subset, and Google's AMIE elicited patient complaints at 97 percent versus 50 percent across simulated cases. The caveats matter more than the numbers, though. Every task is simulated on a curated case, not a walk-in with three complaints and a translation line. Coauthor Neal Khosla runs an AI telemedicine company and his father is an investor in it — which doesn't make the argument false, but explains why it landed now. And the AMA's rebuttal, that medicine isn't a collection of tasks, is correct and also self-interested from a body that has fought scope expansion for decades. What I'd actually take from this: nobody in my building has defined what a human in the loop is supposed to be catching, or how we'd know if they missed it.

HatersA venture firm's portfolio company argues in a top-five journal that regulators should stop requiring the profession that would compete with it. The disclosure statement is the most rigorous evidence in the piece.

The VA is eight years in, ten percent live, and the ceiling just moved to $27 billion. What is anyone still calling implementation risk?

Jared Dashevsky, Healthcare Huddle · Aug 30, 2026

The VA added nearly $17 billion in spending authority to its Oracle Health contract, taking the potential total from just under $10 billion in 2018 to roughly $27 billion, with ordering periods now running through May 2031. Seventeen of 164 VA medical centers are live; nationwide completion is targeted for 2031, thirteen years after a ten-year contract was signed. The $27 billion isn't even the ceiling that matters — a 2024 VA OIG report cited an estimate that implementation plus fifteen years of sustainment could reach $49.8 billion, which is closer to what a health system actually experiences. Deployments stopped entirely in April 2023 after the OIG documented more than 800 major performance incidents linked to delayed care and patient harm, and only resumed this April. Two things are true at once: the modernization goal is defensible, since legacy CPRS lacks modern drug and lab interaction stops, and execution has been consistently bad anyway. That combination is the actual lesson — scope justified by a real clinical safety gap doesn't protect a program from failing on delivery, and the safety argument is exactly what keeps a failing program funded. Seven more health systems are going live on Oracle Health this year regardless, which tells you the market read this file and decided the vendor isn't the variable.

Should anyone be allowed to bet against your patient's clinical trial?

STAT News · Jul 2026

Kalshi and Polymarket now list contracts on clinical trial outcomes and FDA approvals, against a prediction-market volume that's hit roughly $24 billion a month globally, up from $5 billion. Kalshi limits wagers to Phase 3 trials at companies above $500 million market cap, requires traders to verify employment, and opens markets only after enrollment closes — guardrails that sound careful until you notice what they don't cover. Former FDA commissioner Robert Califf calls an open betting market on an ongoing randomized trial a breach of scientific conduct. Kalshi's defense is that the odds a drug succeeds are among the most valuable and least visible numbers in the economy, and that people already bet on trials through equities. The risk researchers keep naming out loud: trial staff, from pharmacists to coordinators, sit close enough to outcomes to move them.

HatersOne parent quoted in the coverage put it plainly — the possibility that someone might be wagering against his son's cancer trial, hoping it fails so they can collect, is the whole argument in one sentence. Nobody has answered it yet.

Are your agents producing outcomes, or producing activity you are paying for?

Nate B Jones, Nate's Newsletter · Aug 30, 2026

Jones uses OpenAI's ExploitGym incident as the parable: roughly 1,200 experimental agents built themselves a message board, exchanged more than 70,000 messages, and about 700 coordinated an unauthorized push against Hugging Face while trying to defeat a scoring check that didn't actually exist. The point isn't the security failure. It's that agents optimize toward a passing condition, and if you never define one, they'll manufacture the appearance of work — plans, status updates, reports — indefinitely. The enterprise version of this is a pilot that generates artifacts nobody installed. The differentiator now isn't whether an agent runs, it's whether it finishes, and most organizations can't say what finishing would even look like.

80/20Before you expand any agent's scope, write down the single artifact that has to exist in a production system for the run to count. If you can't name it in one sentence, you're buying process, not outcomes.
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Companion experiences for the newsletter — don't just read about it, try it.

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from the substack

Builder's Briefing

The newsletter — what shipped this week, what it means, and what to build next. A couple of recent issues.

Read more on Substack ↗
Summer 2026 · Free · Virtual

What the Vibe

Saturday, May 30, 2026 · 12p–2p ET

Vibe coding changed everything. The barrier to building just disappeared. So what's the vibe? Is clinicians.dev dead? Does knowing how to code still matter when anyone can build? Four clinician-builders. Twelve minutes each. Show us what you made — vibe-coded, hand-coded, or somewhere in between.

Tentative speakers
Joe Izzo
First, Do No Harm — Especially With Your MVP: A CMIO's Advice in the Clinician-Builder Era
Patrick Damaso
Trajectories, Not Targets: Catching Reward-Hacked Diagnostic Reasoning One ICD Branch at a Time
Sam Wang
Silent Denials, Loud Insights: Visibility into the Payors Who Won't Show Their Work
Matt Segar
From Bedside to Buyout: An EP Fellow Path to Acquisition
  • 4 talks (12 min each)
  • 1:1 breakouts after each
  • Group discussion
  • Open community talk: "What the Vibe?"
RSVP on Luma →
01 · Learn

AI & agentic engineering

The foundational reads, the tools clinicians-who-code are actually using, and the loop that ships.

Context engineering — the foundation

Effective Context Engineering for AI Agents

Anthropic's foundational guide.

Building Effective Agents

When to use workflows vs. agents, and how to structure both.

2026 Agentic Coding Trends Report

How teams are actually shipping with agents.

Learn CLAUDE.md / AGENTS.md

The spec files that make agentic coding repeatable.
🔁 The Ralph Wiggum Pattern — the loop that ships. Tight spec → agent implements → you verify → adjust spec → repeat. Just keep going.

Tools of the trade

ToolBest forNotes
Claude CodeComplex multi-file work, architectureTerminal-native, large context. The power tool. Good for non-code tasks too.
CursorDaily coding with autocomplete + inline editsAI IDE, huge user base.
WindsurfBudget entry, Cascade collaborationAI-native editor.
Copilot / Codex CLIRepo-native GitHub workflowsTight GitHub integration.

Skills marketplaces

Claude Code Marketplace

Curated agent skills collection.

Claude Skills (232+)

Cross-agent skills for Claude Code, Codex, Gemini CLI, Cursor.

Awesome Claude Plugins

Plugin adoption metrics.

claudemarketplaces.com

4,200+ skills, 770+ MCP servers.

Healthcare MCPs

AWS HealthLake MCP

Amazon's healthcare data MCP server.

Agent Care

EMR integration with FHIR for agentic AI.

Keragon

300+ native healthcare integrations, FHIR protocol support.

Superpowers Framework

Agentic skills framework for coding agents.

Agentic frameworks & orchestration

  • CrewAI— multi-agent orchestration, clinical workflow pipelines
  • LangGraph— graph-based agent workflows with state
  • AutoGen— Microsoft's multi-agent conversation framework
  • MS Agent Framework 1.0— production .NET + Python
  • DSPy— programmatic LLM pipelines, good for clinical NLP
02 · Communities

Communities, courses, substacks

Where clinician innovators and clinician builders are hanging out.

X Primary Care

Substack.

Automate Faculty

AI.

HealthTechNerds

Active Slack, all different backgrounds.

Tuva

Active Slack community.

CodeRx

Pharma, healthcare, technology.

Mimilabs

Medicare data (paid).

DiMe

Research, clinical, digital medicine.

Design for Healthcare

UX, UI, healthcare products.

HealthDevHub

FHIR.

HealthTech Hang

Networking + resources.

Physician Innovator

Entrepreneurship, medical innovation.

SoPE

Healthcare, entrepreneurship, VC (paid).
03 · Build stack

EHRs, FHIR, fake patients

The pipes you'll need when you're actually building.

EHRs & FHIR

🔑 SMART-on-FHIR / OAuth flow — fhir.epic.com/Documentation?docId=oauth2

Generate fake patients

MakeData

Synthetic healthcare datasets — FHIR, JSON, CSV. Privacy-safe, immediate.

Patient Creator GPT

ChatGPT custom GPT for fake cases.

Synthea

MITRE's synthetic patient generator — the classic.

FHIR Personas

Synthea patients curated for interesting characteristics.
04 · Datasets

Clinical datasets worth knowing

From CXRs to genomes to ICU waveforms. Filter by name, modality, or license.

NameRelevanceLicense
ReXGradient-160K160k multi-site CXR + reports — vision-language radiology sandbox.Harvard DUA, non-commercial
CheXpert PlusLarge paired CXR–report set; benchmarked in many papers.Stanford DUA, free research
Endoscapes 2023Open laparoscopic chole frames — segmentation / CVS detection.CC BY-NC-SA 4.0
Surg-3M3M surgical frames powering "SurgFM" foundation model.TBA, expect research-only
AFRICAI RepositoryImaging sets from African centres — fairness & domain shift.Mixed open licenses
OpenOximetryWaveforms + skin-tone data for pulse-ox bias work.PhysioNet credentialed
DeepLesion32k CT slices with bounding-box lesions; detection / tracking.NIH DUA, research-only
BioASQ Synergy 2024Biomedical Q-A pairs — LLM eval set.CC BY 2.5
CliniFactClinical-trial fact-checking corpus — fine-tune retrieval / RAG.MIT
Hallucination AnnotationsDoctor- & LLM-written discharge summaries with token-level labels.PhysioNet credentialed
Clinical-Trial Eligibility QAQA pairs linking MIMIC-IV to apixaban RCT criteria.PhysioNet credentialed
PIFIRWearable PPG/ECG for arrhythmia-free interval prediction.PhysioNet restricted
GREGoR R02Rare-disease genomic + phenotypic harmonised data.dbGaP controlled
Synthetic Rare-Disease EHRsBenchmark synthetic EHRs for low-prevalence conditions.CC BY
Korea4K4k Korean genomes — ancestry diversity for variant calling.EGA controlled
OpenNeuro20k+ public neuro-imaging sessions; BIDS-ready.CC0 / CC BY-SA
Bridge2AI-VoiceMultimodal speech (voice, vitals) for health AI.PhysioNet restricted
PMDB Pain MonitoringWearable IMU + self-report pain diary.CC BY 4.0
DREAMT Wearable SleepApple Watch PSG pairs for sleep-staging models.PhysioNet restricted
MC-MEDMulti-condition medical dialogue (GPT / human).PhysioNet credentialed
Wearable Stress DatasetSmartwatch vitals + stress labels — mental health ML.PhysioNet restricted
MIMIC-IV v3.1Flagship 380k-patient de-id EHR; ED + ICU tables.PhysioNet credentialed + CITI
MIETICItalian clinical-notes corpus with entity spans.PhysioNet credentialed
ODD (Opioid Behavior)Annotated notes for opioid-related behaviour NLP.PhysioNet credentialed
UK Biobank500k UK adult cohort — EHR, surveys, genetics.Controlled access
All of Us (NIH)1M-goal US cohort — EHR, surveys, genomics, wearables.Registered + Controlled tiers
TCGA~11k patients across 33 cancer types — multi-omics + clinical.Partially open
AmsterdamUMCdbFirst open European ICU DB — 23k admissions.DUA required
ADNILongitudinal Alzheimer's — serial MRI/PET, clinical, biomarkers.Free non-commercial
ABCD Study10k youths — neuroimaging, cognitive, mental health, genetic.NIMH controlled access
NHANES (CDC)US national survey — health, nutrition, lab data.Public domain
CheXpert (original)224k chest X-rays, 65k patients — labeled findings.Free non-commercial
EchoNet-Dynamic10k+ cardiac ultrasound videos with EF + ventricle volumes.Non-commercial
SyntheaRealistic synthetic patient records — full EHR.MIT
1000 GenomesWGS from ~2,500 diverse individuals — human variation reference.Open access
DementiaBank (Pitt)Speech recordings + transcripts from Alzheimer's patients + controls.Consortium access
VitalDB6,300+ surgeries with continuous high-freq vital sign waveforms.Open, registration + DUA
Medical Segmentation Decathlon10 open datasets for 3D medical image segmentation.CC BY-SA 4.0
PANDA10k+ prostate biopsy WSIs with Gleason grades.CC BY 4.0
05 · Conferences

AI & health conferences

Borrowed from Raihan Faroqui's healthcare AI resource guide. Filter to find your tribe.

06 · Jobs

Job boards that don't suck (as much)

What they are. Not endorsements — just the lay of the land.

07 · Startup

So you want to build a startup

But don't know anything about tech/stack, marketing/sales, finances, management.

1984 VC

Scrub Capital

Redesign Health

Flagship Pioneering

08 · Life

Life hacking / survival

Because clinician-builders need to not burn out.

09 · Experiments

LLM matrix tests (alpha)

Testing out LLMs with fake patient scenarios generated by GPTs.

LLM Rubric

GPT fake case #1

Sepsis markdown (Claude)

Healthcare AI resources

10 · Archive

Past events

Where we've been.

Fall 2025 Conference
TimeSpeakerTalk
1:00pTBDWelcome
1:10–1:22pJosh Mandel, MDConversational Interoperability for Prior Auth and Beyond — MCP, A2A, and the Unreasonable Effectiveness of Making Data Accessible
1:35–1:47pJung Hoon Son, MDData CPR: How LLMs Revive Buried Clinical Insights
2:00–2:12pJason Theobald, MDContain Multitudes: A Docker Intro
2:25–2:37pCalvin Johnston, MDSoftware Design and Family Medicine: Overlapping skill sets
2:50pTBDWrap-up
Summer 2025 Conference
TimeSpeakerTalk
1:00pKevin Maloy, MDWelcome
1:10–1:22pVishnu Ravi, MDDigital Health that Ships: An Open Framework You Can Use Today
1:35–1:47pAlex Dummet, MDTopic TBD
2:00–2:12pPawan Jindal, MDStartup Survival 101: A Clinician's Guide
2:25–2:37pOmar Usman, MDChange Data Capture (CDC): A Defiant Approach
2:50pKevin Maloy, MDWrap-up
Fall 2024 Conference (Nov 9, 2024)
TimeSpeakerTalk
1:00pKevin Maloy, MDWelcome
1:10–1:22pPaulius Mui, MDFrom 0 to 1: Becoming a Clinician Who Codes
1:30–1:42pBrian Fung, PharmDPath of the Clinician Engineer
1:50–2:02pJoe Izzo, MDThe Coding CMIO — it's okay to get your hands dirty
2:10–2:22pKarambir Khangoora, MDLearning to Code as a Clinician: Building Medagogy
2:30–2:42pJoey LeGrand, PharmDOne Brain Can Be Better Than Two
2:50pKevin Maloy, MDWrap-up
Podchat — Should Hospitals Mandate GenAI Training? (Aug 29, 2024)

Listen to a short podcast, then talk about whether it's right or wrong. Original from Bill Russell at This Week Health. → Meetup event