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.

✉ Email for Slack invite → Slack → Substack ↓ Next event

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.

Medicare just started paying only when the patient actually gets better

techysurgeon · Jul 6

As of July 5, CMS's Innovation Center switched on the ACCESS Model — a 10-year test that pays a recurring per-patient Outcome-Aligned Payment only when validated patient-reported outcomes improve. It's a quiet but real shift from buying activity to buying results. The question it puts to every builder: is your delivery model built to be graded, or only to be billed?

BuilderIf your product can't produce a clean, validated PRO signal that moves over time, you're on the wrong side of this payment change. The teams that instrument outcomes now will be the ones that get paid under it.

"ChatGPT is a better doctor than 99% of doctors" — the stat is a game of telephone

Doug Fullington, MD · Jul 6

The viral line is a distortion. Andreessen said that 99% of the time a frontier model gives him a better answer than a reachable expert — a claim about frequency of answers — and the repost chain quietly flipped it into "better than 99% of doctors." A better answer is not a better doctor. Worth having a calm version of this ready for the patient who walks in quoting the headline.

HatersA model that's right more often than your on-call colleague still isn't practicing medicine — it isn't examining the patient, carrying the risk, or owning the follow-up. Fluency in answers keeps getting mistaken for the job.

ONC handed TEFCA auditing to a DC contractor almost nobody in health IT has heard of

Brendan Keeler · Health API Guy · Jul 6

ONC awarded a ~$1.8M TEFCA auditing contract to Alliance Global Tech, a little-known GovCon firm — a new independent auditing function sitting alongside, not replacing, the Sequoia Project. Keeler reads it as the setup for the next shoe: a real info-blocking crackdown. If you move clinical data, it's worth knowing who your referee just became.

A pacemaker maker just lost 3.8 million patients' data

The Register · Jul 2

Medtronic is notifying 3.8 million people of a breach. The uncomfortable board-level question it hands the rest of us: if a device company of that scale and maturity can lose this much, what's the honest answer when someone asks whether it could be us? Vendor risk isn't a checkbox on the diligence sheet — it's the surface you're actually exposed on.

A single tube of blood that reads the tumor's "soil," not just its cells

Ground Truths · Eric Topol · Jul 6

Stanford's Aaron Newman built an AI tool ("Spatial Ecotyper") trained on 10 million single-cell RNA-seq profiles across 10 cancers to define nine conserved spatial ecotypes of the tumor microenvironment — then extended it to a blood-based "Liquid Ecotyper" that reads that biology from cell-free RNA. The frontier is moving from single biomarkers to AI-derived, serially sampled biology.

BuilderThe reimbursement and decision-support surface for "read the microenvironment over time" doesn't exist yet. That gap is the whitespace — if you build in diagnostics or CDS, this is where the next category gets defined.

The direct-to-consumer lab boom isn't medicine — it's built for the worried-well wealthy

Healthcare Huddle · Jared Dashevsky, MD · Jul 6

The DTC lab market was ~$3.5B in 2024 and is projected at $6–8B by the early 2030s, with WHOOP, OURA, Quest and LabCorp all now in it. But there's still no strong evidence these 50-to-160-biomarker panels improve outcomes in asymptomatic people. Handy framing for the next patient who waves a full panel at you: if these truly improved outcomes, wouldn't standard practice already be ordering them?

Read the full wire ↗

learn by doing

Interactives

Companion experiences for the newsletter — don't just read about it, try it.

The Machine That Saves Billions

July 13, 2026 · Source: MedCity News — "Prior Auth Is a Fight and AI Won't End It" · CMS Medicare Advantage MLR 2023 · via MIMI Labs

Today's Big Thing says AI can't "end" prior auth because no payer unplugs a machine that saves it billions. Here's the machine: 571 real Medicare Advantage contracts, plotted by enrollment vs. medical loss ratio — the share of premium kept out of claims. The giants cluster right above the 85% federal floor and kept $40B between them; the industry kept $57.3B. Light up the billion-dollar valves, then drag the sample-size floor and watch the "some plans keep 25 cents" outliers dissolve into small-n noise.

The Denials Nobody Fought

July 13, 2026 · Source: MedCity News — "Prior Auth Is a Fight and AI Won't End It" · KFF 2023 MA prior-auth analysis

In 2023, Medicare Advantage plans denied 3.2 million of ~50 million prior-auth requests. In 1,000 dots: reveal the 6.4% denied, then re-base the field to the denials and follow them — 88% were never appealed, and of the 12% that were, 82% got overturned. The denials that stuck, stuck mostly because nobody fought them. Critical lens: the 82% overturn rate ranges from 42% (Kaiser) to 94% (Centene), and the 6.4% average hides far higher post-acute denials.

Browse all interactives →

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.

TEFCA's referee is an algorithm 🤖, Claude plays doctor 🩺, Real questions beat board exams 📊

Who referees the network?

Read on Substack →

Primary care declares independence 🗽, Two AI laws go live ⚖️, UpDoc's paperwork tells another story 🔍

He earned a PhD in AI, then went to med school on purpose.

Read on Substack →

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

Tool	Best for	Notes
Claude Code	Complex multi-file work, architecture	Terminal-native, large context. The power tool. Good for non-code tasks too.
Cursor	Daily coding with autocomplete + inline edits	AI IDE, huge user base.
Windsurf	Budget entry, Cascade collaboration	AI-native editor.
Copilot / Codex CLI	Repo-native GitHub workflows	Tight GitHub integration.

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.

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

Clinical datasets worth knowing

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

Name	Relevance	License
ReXGradient-160K	160k multi-site CXR + reports — vision-language radiology sandbox.	Harvard DUA, non-commercial
CheXpert Plus	Large paired CXR–report set; benchmarked in many papers.	Stanford DUA, free research
Endoscapes 2023	Open laparoscopic chole frames — segmentation / CVS detection.	CC BY-NC-SA 4.0
Surg-3M	3M surgical frames powering "SurgFM" foundation model.	TBA, expect research-only
AFRICAI Repository	Imaging sets from African centres — fairness & domain shift.	Mixed open licenses
OpenOximetry	Waveforms + skin-tone data for pulse-ox bias work.	PhysioNet credentialed
DeepLesion	32k CT slices with bounding-box lesions; detection / tracking.	NIH DUA, research-only
BioASQ Synergy 2024	Biomedical Q-A pairs — LLM eval set.	CC BY 2.5
CliniFact	Clinical-trial fact-checking corpus — fine-tune retrieval / RAG.	MIT
Hallucination Annotations	Doctor- & LLM-written discharge summaries with token-level labels.	PhysioNet credentialed
Clinical-Trial Eligibility QA	QA pairs linking MIMIC-IV to apixaban RCT criteria.	PhysioNet credentialed
PIFIR	Wearable PPG/ECG for arrhythmia-free interval prediction.	PhysioNet restricted
GREGoR R02	Rare-disease genomic + phenotypic harmonised data.	dbGaP controlled
Synthetic Rare-Disease EHRs	Benchmark synthetic EHRs for low-prevalence conditions.	CC BY
Korea4K	4k Korean genomes — ancestry diversity for variant calling.	EGA controlled
OpenNeuro	20k+ public neuro-imaging sessions; BIDS-ready.	CC0 / CC BY-SA
Bridge2AI-Voice	Multimodal speech (voice, vitals) for health AI.	PhysioNet restricted
PMDB Pain Monitoring	Wearable IMU + self-report pain diary.	CC BY 4.0
DREAMT Wearable Sleep	Apple Watch PSG pairs for sleep-staging models.	PhysioNet restricted
MC-MED	Multi-condition medical dialogue (GPT / human).	PhysioNet credentialed
Wearable Stress Dataset	Smartwatch vitals + stress labels — mental health ML.	PhysioNet restricted
MIMIC-IV v3.1	Flagship 380k-patient de-id EHR; ED + ICU tables.	PhysioNet credentialed + CITI
MIETIC	Italian clinical-notes corpus with entity spans.	PhysioNet credentialed
ODD (Opioid Behavior)	Annotated notes for opioid-related behaviour NLP.	PhysioNet credentialed
UK Biobank	500k 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
AmsterdamUMCdb	First open European ICU DB — 23k admissions.	DUA required
ADNI	Longitudinal Alzheimer's — serial MRI/PET, clinical, biomarkers.	Free non-commercial
ABCD Study	10k 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-Dynamic	10k+ cardiac ultrasound videos with EF + ventricle volumes.	Non-commercial
Synthea	Realistic synthetic patient records — full EHR.	MIT
1000 Genomes	WGS from ~2,500 diverse individuals — human variation reference.	Open access
DementiaBank (Pitt)	Speech recordings + transcripts from Alzheimer's patients + controls.	Consortium access
VitalDB	6,300+ surgeries with continuous high-freq vital sign waveforms.	Open, registration + DUA
Medical Segmentation Decathlon	10 open datasets for 3D medical image segmentation.	CC BY-SA 4.0
PANDA	10k+ 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.

jobs.heyhealthtech.com
Rock Health Capital
MDisrupt
PharmDs in IT
AMIA
General Catalyst— surprisingly good for startups
Matchday Health
Wellfound
Look for Zebras
Fractional Jobs
HealthTech Nerds Jobs

07 · Startup

So you want to build a startup

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

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.

Past events

Where we've been.

Fall 2025 Conference

Time	Speaker	Talk
1:00p	TBD	Welcome
1:10–1:22p	Josh Mandel, MD	Conversational Interoperability for Prior Auth and Beyond — MCP, A2A, and the Unreasonable Effectiveness of Making Data Accessible
1:35–1:47p	Jung Hoon Son, MD	Data CPR: How LLMs Revive Buried Clinical Insights
2:00–2:12p	Jason Theobald, MD	Contain Multitudes: A Docker Intro
2:25–2:37p	Calvin Johnston, MD	Software Design and Family Medicine: Overlapping skill sets
2:50p	TBD	Wrap-up

Summer 2025 Conference

Time	Speaker	Talk
1:00p	Kevin Maloy, MD	Welcome
1:10–1:22p	Vishnu Ravi, MD	Digital Health that Ships: An Open Framework You Can Use Today
1:35–1:47p	Alex Dummet, MD	Topic TBD
2:00–2:12p	Pawan Jindal, MD	Startup Survival 101: A Clinician's Guide
2:25–2:37p	Omar Usman, MD	Change Data Capture (CDC): A Defiant Approach
2:50p	Kevin Maloy, MD	Wrap-up

Fall 2024 Conference (Nov 9, 2024)

Time	Speaker	Talk
1:00p	Kevin Maloy, MD	Welcome
1:10–1:22p	Paulius Mui, MD	From 0 to 1: Becoming a Clinician Who Codes
1:30–1:42p	Brian Fung, PharmD	Path of the Clinician Engineer
1:50–2:02p	Joe Izzo, MD	The Coding CMIO — it's okay to get your hands dirty
2:10–2:22p	Karambir Khangoora, MD	Learning to Code as a Clinician: Building Medagogy
2:30–2:42p	Joey LeGrand, PharmD	One Brain Can Be Better Than Two
2:50p	Kevin Maloy, MD	Wrap-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

clinicians.dev

The Wire

Interactives

Builder's Briefing

What the Vibe

AI & agentic engineering

Context engineering — the foundation

Learn CLAUDE.md / AGENTS.md

Tools of the trade

Skills marketplaces

Healthcare MCPs

Agentic frameworks & orchestration

Communities, courses, substacks

EHRs, FHIR, fake patients

EHRs & FHIR

Generate fake patients

Clinical datasets worth knowing

AI & health conferences

Job boards that don't suck (as much)

So you want to build a startup

Life hacking / survival

LLM matrix tests (alpha)

Past events

Learn `CLAUDE.md` / `AGENTS.md`