Conway's Law and Misaligned Incentives

This week, JCal sat down with Shiv Rao at LAUNCH Fest 2026. Shiv is a cardiologist, CEO, and co-founder of Abridge, a $5B+ company that's raised close to $1B to build vertical large language models for healthcare. Shiv breaks down why the US healthcare system is broken, how AI is already outperforming doctors on average, and what it took to build a unicorn in one of the most regulated industries on the planet.

We explore how AI is transforming doctor-patient conversations, eliminating clinician burnout, and reshaping how care is delivered and paid for.

• Doctors Need 30 Hours a Day: An American Journal of General Internal Medicine study found physicians can't complete their daily workload in 24 hours. Shiv explains where all that time goes anAbridge is clawing it back.
• AI Has Better Bedside Manner Than Your Doctor: Research from Harvard and other institutions now shows AI delivers more consistent answers and patients actually prefer it. Shiv explains why that's not as scary as it sounds.
• The Healthcare Stakeholder Problem: Shiv invokes Conway's Law to explain why every player in the system, doctors, insurers & hospitals are pointing guns at each other instead of aligning around the patient.
• A Real-Time AI Copilot for Doctors: Abridge's live assistant listens to conversations, pulls context from years of patient data, and prompts doctors with follow-up questions mid-visit to unlock insurance approvals on the spot.
• The Self-Directed Patient Explosion: Nearly every patient walks in armed with ChatGPT research. Shiv explains why this is compounding the burnout crisis, not solving it.
• Go-To-Market in Regulated Industries: Why "start small and swim upstream" can be a death trap in healthcare, and how Abridge's decision to target large health systems early became a core part of their moat.
• Being Early Isn't Being Wrong: Abridge started three months after "Attention Is All You Need" and raised a $3M seed on a $12M pre. Shiv shares what it was like waiting years for the market to catch up.
• Robotics in Healthcare: From AI-powered suturing at Johns Hopkins to the case for humanoid EMTs, Shiv lays out what's coming and what's still far off.

🔗 Learn more about Abridge: https://www.abridge.com

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Timestamps:

00:00 Welcome & intro to Shiv Rao, CEO & co-founder of Abridge

01:20 Rural hospital closures & the necessity of AI agents

03:33 Designing an AI intake process for primary care

06:01 Solving the 30-hour workday & clerical burnout

08:25 Conway’s Law & misaligned stakeholders in healthcare

10:07 Quadratic - Bringing the productivity boost of AI into your spreadsheets. Visit https://www.quadratic.ai/twist to sign up and use the code TWIST to get one free month of their pro tier subscription.

11:50 Why patients prefer AI models over average clinicians

14:27 Moving past the charade of the all-knowing doctor

17:01 How automated notes restore human clinical presence

21:00 The Joe Rogan crowd & consumer-driven healthcare

27:29 Advances in surgical robotics & AI precision

32:44 Surviving the Bert era to reach the AI inflection point

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