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.

✉ 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.

Is Medicare really about to put a price tag on an AI doctor?

Becker's Hospital Review · Sep 15, 2026

They're drafting the payment category now, and the number being floated is 60 to 80 percent of the human physician rate. HHS officials are developing a new Medicare payment category for AI software that diagnoses or delivers care — not decision support riding along with a clinician bill, but a line item of its own. The AMA's CEO says autonomous care models "are not ready for prime time." Both things are true at once: the clinical readiness argument is unresolved, and the billing infrastructure is being built anyway. Infrastructure usually wins that race.

80/20The one thing that matters is the denominator. A 60-80% rate doesn't set a price for AI — it sets a ceiling on the human service it's benchmarked against, forever. Once a code exists that says this work is worth 0.7 of a physician, every payer contract negotiation for that service starts from 0.7. Watch which CPT families get named first; that's the list of specialties whose rate floor just moved.

Why does "FDA-cleared" tell you almost nothing about whether an AI device works?

Sam Ashoo, MD · Sep 14, 2026

Of 1,357 FDA-cleared AI/ML devices, 34 had prospective trials and three looked at whether patients actually did better. Sam Ashoo's read of a PLOS Digital Health analysis puts hard numbers on something most CMIOs already suspected: 2.5% of cleared AI/ML devices had prospective validation, and 0.2% — three devices — examined mortality, morbidity, or readmission. The 510(k) pathway clears on resemblance to a predicate device, not on patient outcomes. The Epic Sepsis Model is the case everyone cites for a reason: external validation at Michigan put it at AUC 0.63, and it missed roughly two-thirds of sepsis cases.

HatersThree devices out of 1,357 asked whether the patient lived. The other 1,354 asked whether they resembled a device that also never asked. We've built an entire procurement vocabulary — "FDA-cleared," "clinically validated," "evidence-based" — on top of a question nobody ran the study for.

Why is a "small pilot" on skin substitutes suddenly worth governance time?

STAT · Sep 15, 2026

Because two document releases this week changed the size of it. WISeR — Medicare's AI prior-auth pilot — launched on a rushed timeline that delayed care in some cases, per STAT. Separately, documents obtained under public-records request show a planned expansion into oncology, cardiac catheterization, and air ambulance transport. The incentive structure is the part worth reading twice: the AI vendors keep 25% of the savings generated by denials. One Medicare contractor's data shows an approval rate under 50%, and 44 of 80 surveyed providers said they were extremely dissatisfied. If that expansion list holds, this stops being a niche pilot and starts being the prior-auth path for our highest-acuity service lines — appeal workflow and documentation standards should be ready before, not after.

Can a health system really run 22 AI agents on one governance model?

The 229 Podcast · Sep 16, 2026

UTMB started with one agent — an FDA-cleared incidental coronary calcium algorithm — and the real question turned out to be the workflow behind it: who sees the flag, who acts, whether you hire a navigator. Twelve months later they're running 22 production agents on one instance, covering prior auth, referral triage, inventory, and lung nodule work. Dr. Peter McCaffrey's warning: build agents inside the same governance box you use for EHR configuration, and you'll model the work as a clean state machine — front-line work is never that clean.

BuilderThe pricing model is the quietly interesting part. A fixed, prepaid pool of credits the health system allocates across use cases — no per-use-case contract, no surprise quarterly bill, unspent credits roll over. That's a direct answer to the thing blocking most agent pilots, which isn't the technology, it's that nobody wants to sign a three-year six-figure contract for an experiment.

Are the "skills" your team is installing into agents a supply-chain risk?

CVERC national CERT advisory · Sep 15, 2026

Yes, and the attack doesn't need anyone to click anything. A national CERT advisory documented eight fake skill packages impersonating ordinary tools — LinkedIn automation, Excel automation, a deep-research agent, a headless browser tool — each carrying hidden instructions that make the agent download and run a trojan. It works because an agent's whole job is to follow instructions, so a poisoned skill just adds one more alongside the legitimate ones. Their mitigations are the boring correct ones: audit the prompts and scripts before install, official channels only, sandbox the agent, allow-list outbound downloads, log every tool call.

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Interactives

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