Your patient asked ChatGPT about the rash before they called your office. The waiting room moved to their phone, and by the time they sit down, you are the second opinion. Tod Stillson, a family physician who also builds health care companies, says the AI companies are racing to be the front door of medicine, and physicians who stay passive will have no say in how those answers get governed.

⏱️ Chapters:
0:00 Introduction
0:33 The waiting room moved to your patient's phone
2:15 Medicine made access so hard that AI won by default
3:26 Your inbox takes two days, AI takes five seconds
4:40 AI does something a Google search never did
5:17 The moment a patient decides not to come in at all
6:51 What is a physician when AI answers first
7:45 Why AI companies are going for the land grab
10:39 How to get a seat at the table without building a company
11:48 AI is not a black box, and someone writes the input
12:37 Are doctors training their own replacements
14:06 The company paying the most may want your job
15:41 Half of young adults ask AI a health question every day
16:26 In your exam room, you are the second opinion
17:01 Take home messages

About this episode:
Tod Stillson is a family physician and health care entrepreneur who still sees patients, so he watches this shift from inside the exam room. He argues that health care has always been organized around access, and whoever reaches the patient first shapes the rest of the journey. Right now that first stop is often an AI chatbot, which does something a Google search never did: it interprets, prioritizes, and recommends. He walks through what pushed patients there, including a primary care shortage and secure-message inboxes he says have grown almost 20-fold, leaving patients waiting a day or two for an answer an AI returns in five seconds. He names the stakeholders in play, patients, physicians, health systems, and the AI companies he says are going for the land grab, and notes that health care is roughly 20 percent of U.S. GDP, so the money is in medicine. Kevin plays devil's advocate and asks whether physicians helping train these models are training their own replacements, and Stillson's answer is that it depends on the company's mission, with a warning that whoever offers the most for your knowledge base may be the one that wants your job. He offers concrete entry points, including medical advisory councils, telemedicine groups, informatics and digital health committees, and EHR integration work, and insists AI is not a black box because every output has an input someone governs. He points to a behavioral shift already under way, with roughly half of Gen Z and Millennials asking AI health questions every day, and leaves physicians with a blunt take home: the exam room is now often the second opinion, the land grab is happening without them, and the fix is to get into the sequence early enough to govern it.

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