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.

Who takes the fall when the clinical AI is wrong?

Becker's · Aug 2026

Four active lawsuits are about to answer that in real time: a Mayo Clinic whistleblower suit over AI oversight, a discovery order forcing UnitedHealth to hand over how nH Predict actually worked in a Medicare Advantage denial case, and a suit over medical guidance ChatGPT gave a patient. Nobody has settled where liability lands — the health system that deployed the model, the vendor that built it, or the clinician who accepted its output — and these four dockets are the live experiment. The UnitedHealth discovery order is the one to watch: whatever surfaces there becomes the template for every future algorithmic-denial claim.

80/20Skip the liability think-pieces. The one thing that matters is what comes out of nH Predict discovery — that becomes the playbook plaintiffs use against every payer and provider running predictive models on patients.

93% of health systems run third-party AI. Only 44% can actually test it.

Fierce Healthcare · Aug 2026

A new UPMC and KLAS report puts numbers on a gap I see constantly: 93% of organizations already deploy third-party AI, but only 44% have a dedicated data platform to test any of it. A separate survey found EHR integration difficulty has overtaken clinician trust as the top barrier to scaling. We're not behind on buying AI — the question worth leading on is whether we can independently verify what we've already bought. Most of the industry can't.

The $10 billion wound-care business that bought its way out of Medicare reform

Zena Wolf, Healthcare Uncovered · Aug 6

Skin substitutes — wound-care grafts — grew from a rounding error to over $10 billion a year in Medicare Part B spending, and the coverage rule that would have reined in pricing got withdrawn days before taking effect, after the dominant middlemen wrote seven-figure checks to politically connected committees. What actually worked anyway: a flat-fee pricing reform that took effect January 1 cut spending to roughly $100 million since implementation — payment design did in months what years of fraud prosecutions couldn't. Manufacturers are now challenging that reform in the Fifth Circuit.

SkepticDOJ handed out 15-year sentences to small-fry providers while the two middlemen who moved $4 billion in Medicare money bought their coverage rule for $200,000 in same-day donations. Enforcement theater for providers, policy access for the platforms.

If 81% of physicians already use AI, why does it feel like nobody's in charge?

STAT News · Aug 7

The AMA's 2026 survey has 81% of physicians using AI professionally, while FDA's narrowed clinical-decision-support oversight is letting unvetted tools into clinics with liability for AI-influenced misdiagnoses still unresolved. The sharper claim in the STAT piece isn't about safety, it's about autonomy: AI is arriving packaged with the same utilization-review machinery that already eroded physician judgment — except this time the recommendations come pre-generated. Whatever you think of the pessimism, the tools reached the bedside faster than anyone decided who answers for them.

Radiology's proving ground just replaced its most biased score

The 229 Podcast · Aug 6

Envision Sally Jobe just became the first outpatient imaging center anywhere to deploy an FDA-cleared, image-based breast-cancer risk model trained on a diverse population — replacing the questionnaire-based Tyrer-Cuzick score built on white European women. Two-thirds of the ~1,200 FDA-cleared healthcare algorithms live in radiology, so how this practice governs them — clinician-led, board-vetted, no shiny-object chasing — is worth studying as a working reference design.

Read the full wire ↗

learn by doing

Interactives

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

The Level Four Line

August 9, 2026 · Source: Barbara Hays & Cindy Hughes, “Coding Level 4 Office Visits Using the New E/M Guidelines”, AAFP Family Practice Management, Jan/Feb 2021 · AMA CPT E/M revisions · MIMI Labs · CMS Physician & Other Practitioners PUF, 2024

Today's essay says the bottleneck isn't code, it's the spec. So this takes the best case: “was that office visit moderate complexity?” — the one clinical judgment America has tried hardest to write down, with a 2021 rewrite, a decision table, audits and money attached. 1,440 clinicians, one dot each, plotted by established-visit volume against the share coded level 4/5. The critical lens is the interaction: CMS suppresses every provider–code row covering ten or fewer beneficiaries, so among clinicians with 11–49 visits, 79.9% have only one of the four codes present and 85% sit at exactly 0% or 100%. Drag the volume slider and that bimodality dissolves on cue — rails to 10%, single-code column to 4% — and the spread underneath does not move. Among the 11,558 clinicians billing 1,500+ established visits a year the middle half still runs 27% to 90%. A second graphic ranks all 31 specialties by their 10th–90th percentile band: podiatry's median is 6.6%, endocrinology's is 95.1%, and the shortest bar on the board is still thirty points wide.

Show Me the Spec

August 9, 2026 · Source: Barbara Hays & Cindy Hughes, “Coding Level 4 Office Visits Using the New E/M Guidelines”, AAFP Family Practice Management, Jan/Feb 2021 · MIMI Labs · CMS Physician & Other Practitioners PUF, 2024

The same finding as a single animated graphic. 1,440 clinicians start stacked on one point — where a working specification would put them — and one button releases them into their actual 2024 numbers, opening to a 67-point interquartile range with a visible pile-up against both walls. Below, the same clinicians split into volume bands with a step-through: at 11–49 visits 89% are pinned to a wall, which is CMS's ten-beneficiary suppression rule rather than clinical practice; by 500+ visits the walls are down to 14% and the middle-half spread is unchanged. National figures on all 540,972 clinicians sit underneath. The piece is careful about what this is not — an older panel, longer slots and a good scribe all legitimately move this number, and claims data cannot separate judgment from documentation habit — but that concession is the argument: nobody can write down how much a scribe should shift your coding either. Those are reflexes too.

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.

Fetal AI lifts 22 points 🤰, Your devices already run AI 🕵️, Part D comes off the drip 💧

⚡ Around the Wards

Read on Substack →

Duke built its own chart reader 🔦, ~80 AnMed sites go dark 🕳️, Being safe vs feeling safe 🤔

⚡ Around the Wards

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`