The Clinical Realist

The Economics Nobody Taught You in Medical School

Medical school teaches you pathophysiology, pharmacology, and clinical reasoning. It does not teach you how the money actually works. In this episode, Dr. Sarah Matt breaks down the economic structures that govern every clinical decision, every technology purchase, and every AI pilot that dies in a committee room: who pays, who decides, who uses, and why those three people are almost never the same person. What you will take away: - The user / decider / payer split and why it explains nearly every failed health-tech deal - How the RVU system shapes physician behavior and silently resists AI adoption - Why value-based care is harder to execute than the architects planned for - The practical questions buyers, vendors, and physicians should be asking before any AI deployment If you want to understand why healthcare moves so slowly, start here. Book a Discovery and Clarity Session: https://calendly.com/sarahmattmd Subscribe to The Sarah Matt Briefing: https://drsarahmatt.com/newsletter-signup — Resources & Links: 📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers. 💼 Work with Dr. Matt: Looking for a keynote speaker or strategic advisor? Visit: drsarahmatt.com 🔗 Connect on Social: LinkedIn: https://www.linkedin.com/in/sarahmattmd/ YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist [http://www.youtube.com/@DrSarahMatt] 📧 Subscribe to The Briefing: drsarahmatt.com/newsletter-signup   — Disclaimer: The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

The Patient We Never Designed For (Live from Cornell Ithaca, Extended Cut)

Recorded live at Cornell Ithaca. This is the extended cut of Dr. Sarah Matt's keynote on the central design flaw in modern healthcare: a system optimized for an "average" patient who does not exist. When you build clinical workflows, EHR defaults, drug dosing tables, and AI training sets around a statistical mean, every patient outside that mean pays the cost in workarounds, missed diagnoses, and unsafe care. And most patients are outside the mean. In this talk, Dr. Matt walks through: - Where the "average patient" assumption shows up in clinical AI, and why it compounds bias instead of correcting it - The design debt baked into EHRs, order sets, and risk calculators - What health systems and physician leaders can do now to design for variance instead of pretending it away - Why the patient we never designed for is the patient most likely to be harmed by the tools we are deploying next Recorded live at Cornell. Audience Q&A included. — Resources & Links: Get the book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers. Work with Dr. Matt: Looking for a keynote speaker or strategic advisor? Visit drsarahmatt.com Connect on social: LinkedIn: https://www.linkedin.com/in/sarahmattmd/ YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist Subscribe to The Briefing: drsarahmatt.com/newsletter-signup — Disclaimer: The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship. — Resources & Links: 📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers. 💼 Work with Dr. Matt: Looking for a keynote speaker or strategic advisor? Visit: drsarahmatt.com 🔗 Connect on Social: LinkedIn: https://www.linkedin.com/in/sarahmattmd/ YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist [http://www.youtube.com/@DrSarahMatt] 📧 Subscribe to The Briefing: drsarahmatt.com/newsletter-signup   — Disclaimer: The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

Sunk Cost, Vendor Lock, and the AI Tools Health Systems Can't Let Go Of

Most clinical AI governance frameworks tell you how to evaluate tools before you deploy them. Nobody talks about how to exit a tool that is not working. In this episode, Dr. Sarah Matt walks through the anatomy of sunk cost bias in health system AI: how it starts (month four or five, mixed performance data, a vendor who keeps resetting the clock), how experienced vendor account teams use it to extend bad contracts, and how to build exit criteria into your governance framework before you ever go live. What you will take away from this episode: - Why sunk cost bias in vendor relationships is a governance failure, not a behavioral one - How vendors use remediation roadmaps to reset your evaluation clock - What a real clinical AI exit criterion looks like: specific, measurable, time-bound, established before go-live - How to execute a clean exit without losing six months to organizational politics - Why the cost of staying with a bad tool grows geometrically — Resources & Links: 📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers. 💼 Work with Dr. Matt: Looking for a keynote speaker or strategic advisor? Visit: drsarahmatt.com 🔗 Connect on Social: LinkedIn: https://www.linkedin.com/in/sarahmattmd/ YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist [http://www.youtube.com/@DrSarahMatt] 📧 Subscribe to The Briefing: drsarahmatt.com/newsletter-signup   — Disclaimer: The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

The Q2 Governance Problem: When AI Goes Live Without a Safety Net

Most health systems that deployed clinical AI in Q1 are now six to eight weeks post-launch and starting to see the governance gap. Dr. Sarah Matt explains what the gap looks like in production, why retrofitting governance is more expensive than building it before go-live, and the four-step rapid governance build for organizations that are already live and need to catch up. — Resources & Links: 📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers. 💼 Work with Dr. Matt: Looking for a keynote speaker or strategic advisor? Visit: drsarahmatt.com 🔗 Connect on Social: LinkedIn: https://www.linkedin.com/in/sarahmattmd/ YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist [http://www.youtube.com/@DrSarahMatt] 📧 Subscribe to The Briefing: drsarahmatt.com/newsletter-signup   — Disclaimer: The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

The Pilot Trap: What Health Systems Get Wrong About Implementation

Your pilot worked. You got approval to scale. Six weeks into full implementation, something is wrong: not catastrophically wrong, just wrong enough to make you wonder whether "it worked in the pilot" meant anything at all. In this episode, Dr. Sarah Matt breaks down the pilot trap: the gap between proving a tool works under controlled conditions and proving an organization is ready to run it under normal operating conditions. Pilots and implementations are not on the same continuum. They measure fundamentally different things. The health systems that scale successfully treat the pilot as a learning vehicle, not a prediction. The ones that get stuck assumed pilot success equaled implementation readiness. What you will take away from this episode: - Why pilot success measures tool performance, not organizational readiness - The three gaps that trap most health systems: motivation, workflow integration, governance - Why resistance to clinical AI is usually not irrational, and how to diagnose the source - How the physician champion role shifts from pilot advocate to implementation steward - Why building governance before implementation begins is the single variable most predictive of scale-up success Website: https://drsarahmatt.com | Book a Discovery and Clarity Session: https://calendly.com/sarahmattmd | LinkedIn: https://www.linkedin.com/in/sarahmattmd/ — Resources & Links: 📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers. 💼 Work with Dr. Matt: Looking for a keynote speaker or strategic advisor? Visit: drsarahmatt.com 🔗 Connect on Social: LinkedIn: https://www.linkedin.com/in/sarahmattmd/ YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist [http://www.youtube.com/@DrSarahMatt] 📧 Subscribe to The Briefing: drsarahmatt.com/newsletter-signup   — Disclaimer: The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.