How Clinicians Are Shaping the AI Their Hospitals Deploy
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Will AI eliminate primary care — or finally give primary care physicians their time back?
That's the central question driving this episode, as Dr. Junaid Kalia, Dr. Harvey Castro, and Ed Marx sit down with Dr. John Dayton — an ER physician who has evaluated healthcare startups as an angel investor, built pilots at Intermountain Ventures, and is now raising a $5M fund — bringing a rare view of what AI looks like from the bedside, the boardroom, and the cap table. Dayton maps how AI decisions actually get made inside health systems: why a technology has to align with the CEO's mission, the CFO's budget, the CTO's existing stack, and clinical staff's real workflow — and why losing any one of those four is where most implementations quietly stall.
For physicians and healthcare enthusiasts who want to separate signal from noise — and understand whether the tools landing on their unit deserve to be there — this is the peer-to-peer analysis that conference keynotes never deliver.
"So many of our patients are DIY-ing with these tools — and if we're not familiar with them, they're going to say: why don't they know this? Why aren't they adding it to their practice?"- John Dayton, MD, MBA
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What You’ll Discover
[00:00] Intro: John Dayton's origin story
[04:31] Why He Never Really Left Medicine
[08:07] How hospitals actually make AI decisions
[10:42] Is an MBA worth it if it's not free?
[14:26] The Decision Making Approach Inside Health Systems
[17:19] The Two Questions Nobody Answers Directly
Referenced in the show:
Transcript
John Dayton, MD, MBA:
So many of our patients are, you know, are kind of DIY-ing with these tools and if we're not familiar with that, we're in a situation where they're, where they're going to say like, you know, why don't they know this?
Edward Marx:
Any recommendations to how do we close this gap between what is possible and is happening out there in the field and then actually making it practical on a daily basis at our hospitals where a lot of the care is given.
John Dayton, MD, MBA:
I need to make sure that what I'm building alliance with the hospital mission. So the CEO is going to like me. I need to make sure I'm going to save the money or produce a new revenue stream or make something more efficient for them. So the CFO is going to like me. I need to make sure what I'm doing integrates with our current, electronic health record and their, and their system and their digital health, you know, stack so that the CTO likes me.
Junaid Kalia, MD:
Good morning everyone. Welcome to Signal and Symptom podcast and today is a special day. Interestingly, John Dayton is a good friend with Harvey and knows Ed, knows me, etc, but his journey is superb.
He's actually a physician first and foremost, then he's a Stanford faculty, then he's a practicing physician.
First take us through your journey, your life journey in terms of from a physician to faculty to entrepreneurship to I don't know, fund vc, fund founder.
John Dayton, MD, MBA:
Yeah, first of all, thanks so much for having me on the show. It's great to connect with you guys.
Just a little bit about background for myself. I'm an emergency physician. I live in Utah. I started practicing in Utah initially and in addition to working in emergency medicine, I like to be involved in innovation. So I I was involved in getting a Utah chapter for society physician entrepreneurs off the ground.
I had transitioned to working up at the University of Utah and where I was doing research on innovative delivery models, looking at freestanding ERs, particularly those built by academic centers, what those kind of metrics were looking like. And you know, obviously Covid changed everything.
Fast forward a couple of years and I was working on the Navajo reservation which was a great experience. I felt really useful. But with everything changing everything I thought, you know, I've been looking at doing innovation and I've been trying to figure out how I'm gonna, I'm gonna add that to my practice and you know, playing around with the idea that you know, ER Doctors we're famous for burning out.
And so I was looking at MBA programs and one of my friends who, who was at Stanford said, you know, we're just starting this Innovation Fellowship, why don't you come join us? And very non traditional fellow.
I've been you know, practicing for, for over a decade but I went back to school excited. What a cool experience. So I was in Palo Alto for two years. I did the Innovation Fellowship and then part of that program was you can do the biodesign faculty Fellowship on top of that.
And they gave me money to pursue an MBA and a phenomenal fellowship.
And so that's been a really interesting journey. But back to my soap day society, physician entrepreneurs. As part of that, setting up all these pitch events, I ended up meeting the local tech transfer experts, local VCs, and local angel investors.
And I was invited to be part of Salt Lake City Angels. So me and two other physicians that were part of that group, we did a lot of digging saying is, you know Is this a big enough need?
Is this something that's going to grow? Is this something that will work? And then ended up leveraging those connections from working as an angel to working in VC. And so now I'm kind of full circle where I've been involved, but this is the first chance to build my own. So I'm, I'm in the process of raising a $5 million fund, me and my partner Jamie Edwards, and I, and our thesis is where I'm a physician that has experience in building effective pilots and regulatory strategy and where he's an operator with a background as an entrepreneur in residence for startup health and with an operator in the telehealth and the RPM space.
We really focused on helping build companies make sure their idea is successful.
Junaid Kalia, MD:
Thank you so much for giving this amazing journey. I'm going to let, Harvey, go first because he's in Amazon and Starlink may actually not go through this, Harvey, amazing journey. I have so many questions, but I'll let you go first.
Harvey Castro, MD, MBA:
Well, John, thanks for coming, buddy. I always like asking the question why, why do you do what you do?
You know, is it the AI, healthcare, or is it the improvement of health? Is it the technology? What, what is the job that's pushing you to do all these things?
John Dayton, MD, MBA:
You know, it's a great question. I think it's kind of a combination of being a physician in general and then being an emergency physician as well.
I think we're kind of self-selected to kind of help people get better. And then in the ER we see it's kind of a, you know, microcosm of the health system, we see the emergencies from every specialty, but we're also the safety net. So if something else is failing the system, we stayed in the ER.
You know, we bring care to this network, we leverage a lot of telehealth, and it's a smart way to bring several different kinds of acute care to a smaller community.
You know, we feel like we utilize those resources well. And so that was some of, some of the initial research I was doing is figuring out, all right, is this a safe model? Can we do it? And ASAP, gave me the opportunity to lead a task force on that, to say, you know, we, we should standardize this.
You know, just like we're talking about AI right now with guardrails and standards. Like at the time, it's like, if we're going to have freestanding EDs, how do we make sure that they represent the best of emergency medicine?
And so, that was an interesting thing to do. And as I kind of changed my focus as far as research, with artificial intelligence, obviously, I did not dive in to the length that Harvey had.
But I realized I'm going to need to know how this works if I'm going to utilize it in practice.
And so trying to look at what are the resources that are online, what are the communities that are meeting, who are the, who are the experts in the space that we can follow. And so I, I built a big upskilling document on, on LinkedIn saying hey, if you're wanting to be on top of AI, here, here are some resources for you.
And so that's, that's where I've been with kind of my focus of research and knowledge translation and kind of helping build, trying to figure out the best way to provide care.
I think looking at AI on some of these tools in general, I think there's you know, some, some nervousness, you know, some of our colleagues or there's something that like there's, there's. Because they think, oh, I don't know how to do this, I can't jump in.
And really that's how we improve healthcare because we see the pain points and we're the best position to say, hey, this is something that needs to be done to, you know, advance, you know, whatever process we're trying to fix.
Yeah, so I'm just going to echo what John and actually you're saying the fact that we can now show an MVP and say to the VC or the hospital, hey, this is how it works.
Harvey Castro, MD, MBA:
Now, my favorite phrase is we don't know what we don't know. For example, in the 22 in a row, ChatGPT healthcare people like, perfect. What the hell are you talking about? ChatGPT Health, they're like, I don't understand. Fast forward. A couple months ago, OpenAI now has ChatGPT Health as an official product.
Another example, when generative AI started becoming a thing in 23, I started showing discharge instructions, using comic strips, using, cartoons, and converting and helping hospitals and children's hospitals how to create this, moat.
So my point is, I'm now able to go to a CEO, go to a vc and be like, look, here's, here's how this works. Here's a real example
John Dayton, MD, MBA:
That brings up another great point because so many of our patients are, you know, are kind of DIY-ing with these tools and if we're not familiar with that, we're in a situation where they're, where they're going to say like, you know, why don't they know this?
Why aren't they adding it to their practice?
Junaid Kalia, MD:
There's one thing to think of gold standard and full authority and trustworthiness and there is one thing that they're going to use it. What the hell are we going to do? So question to John and comments on what he just said.
Edward Marx:
And so, John, you're obviously a very learned person, and you've done all these, you know, at Stanford, you were describing all the different programs you went to at MIT, and now with the venture fund, you have all this exposure. How would you recommend? So how does all of this translate down to the hospital?
Any recommendations to how do we close this gap between what is possible and is happening out there in the field and then actually making it practical on a daily basis at our hospitals where a lot of the care is given.
John Dayton, MD, MBA:
Yeah, phenomenal question. And so to speak to that, I'll kind of lean on my experience at Intermountain Ventures. And every hospital system has a set of goals that they're working on for the next year. And, understanding what those goals are and then integrating AI into that can be a big part.
So, you know, within a mountain, a lot of it focus on this year is, are things like supply chain, anything transformative with AI. You know, there's service lines that they want to improve and they want. Want to get better. But with these, really interesting.
And so I think knowing what the hospitals are facing makes a big difference. And, a lot of hospitals are facing the same thing.
They're in a situation where they say, boy, we can use artificial intelligence to really improve these clinical workflows. We've got to make sure it's safe. We've got to make sure the companies we're working with have done life like, you know, pilot work. They have research, they're evidence-based, and then we can move forward.
I need to make sure that what I'm building alliance with the hospital mission. So the CEO is going to like me. I need to make sure I'm going to save the money or produce a new revenue stream or make something more efficient for them. So the CFO is going to like me. I need to make sure what I'm doing integrates with our current, electronic health record and their, and their system and their digital health, you know, stack so that the CTO likes me.
And then I got to make sure this is a need the physicians even want in the first place. So I have, you know, a physician evangelist that's going to support me. And so that, that's a, that's a really heavy task to think I've got to sell to four different people. But you do that by speaking in all their Language. You got to make sure, you know, your vision's aligned, that you're, that your finances make sense, that you're, that you're building something they want that integrates within the system.
You have places like Stanford and Harvard where they're giving their kids, you know, their students LLMs to work with for their education. But not everybody's getting that. So you have to say, what are we going to do for the new grads versus the folks that have been practicing forever? So they have some baseline familiarity with how they can use that and how they can move forward.
And so I think it's really incumbent on hospitals addressing their needs. But then the specialist society is looking at that and then companies that are coming to pitch to them saying, all right, how am I going to, you know, meet the pain points of all these different groups? But that's how they're going to gain traction, that's how they're going to be effective.
Junaid Kalia, MD:
I'm going to push back. And as you know, I ask hard questions. And basically I said rather than, you know, putting money into an MBA, which was free for you, which is again, if it wasn't free, would you do it? That second question. And then the third point is rather, than doing this as a physician. Should they actually join and then get access to real world data? So question number one, should we do an actual MBA if it's not free? Let's just be honest.
If it's free, you should do it. But then the second question is, when you are looking at a VC and you're talking to Junaid Kalia and says, is it More important that he has an MBA or is it more important he has experience in a real startup before, before you fund a new startup?
John Dayton, MD, MBA:
Here's my take and here's why I decided to do an MBA.
MBAs are important for the knowledge and the network. You can get knowledge a lot of different ways, but the network, the network is crucial. The other thing that I like about it is you can be very intentional about the MBA you do. I, I wouldn't recommend just any MBA. I wouldn't recommend just any like EMBA. I was very specific when I looked at it.
I did mine through Johns Hopkins because a lot of, of healthcare leaders go through that.
It's, it's very healthcare driven and they have different subspecials within their MBA. So I did my mba, but I had two focuses. I did healthcare entrepreneurship and I did venture capital. So I studied things very specifically related to what I wanted to do when I finished.
And so I think you have to do the thing that's right for you. I'm not discounting, you know, work that people do on the side. We're physicians, we're lifelong learners by default. That's what going to do it. But I think you have to be kind of intentional about where you get that knowledge, who you're getting it with.
And just one more thing to add. I really enjoy like advising companies and helping them. I really enjoy working in the financial space. But I thought I want to do this better. And I, and I feel like doing an MBA was my, was my key to say, you know, just like we study evidence-based medicines, we go through med school.
What are the best practices for, for building and managing a fund? What are the best practices for advising a company? And I felt like I, I got a better handle on that through my program.
Junaid Kalia, MD:
Absolutely love it. You're absolutely right. I do miss out on a lot of opportunities within because I don't have an MBA.
So I just want to be very clear about it. So I did make a pros and cons. What I just wanted to do was that hey, I don't want to delay two more years to build my startup.
John Dayton, MD, MBA:
So I think you have to figure out what, how do I reach these current goals with my current working situation too. And I think that that's got to be a big question. That factors into how you do it.
Junaid Kalia, MD:
That's truly important too. Right.
I just wanted to make sure that you guys understand that I now have a network of advisors. Right. Harvey, Ed. Now John, he's going to introduce me to VC. I don't have an M & A background so I'm going to get advisors and MA strategists. So there's so many ways to skin the cat.
Do not get hung up on specifics. Start work, you know, crawling so you can walk and then you will run.
Edward Marx:
And I just want to say, and I've, I've said it before in other venues, that if you are, a traditional, like you're talking about traditional physician, do I get my MBA or not? On the other, on the flip side, if you're a leader in healthcare and you don't have any clinical background, you need to figure out ways to get it and you don't have to go to med school, you know, and that's what I did, right?
And so I served one shift a week in the OR, and that gave me a lot of insights I never had.
I had less credibility when I was just tech, but, I had tremendous credibility when people saw that I was willing to spend one.
So there's stuff you could do. I just want to make sure that we share that with the audience, that they should be listening and they're not, not clinicians. They should flip it. Hey, what can I do to get closer to the clinician side as you're trying to get closer to the business side.
Junaid Kalia, MD:
So now tell me, tell me your decision process. Yeah. When you were thinking from a fellowship.
Because again we again the whole point is non clinicians and clinicians to come in the innovation game. We want more people. John, walk people through not in the way that why you made the decision. More importantly if they were making a decision how they should approach. Yeah, you know great question.
John Dayton, MD, MBA:
I kind of going back to something I was saying earlier. ER Docs are famous for burning out. We, you know it's. It's fun to be the guy who leads the trauma team on a Saturday night.
That can get people a little bit depressed. And so it's kind of a thing in emergency medicine, if you're, if you want career longevity, you've gotta, you gotta be like ER doctor Plus, right?
And so I just thought to myself, what's going to be my plus? What's going to keep me into this? And I love setting up these pitch events. I love hearing about these new companies.
And so I, something where I can kind of leverage where I see these pain points in healthcare and I can, you know, give, give, you know, first-person account work.
And I've realized this is something, if you're in the trenches and you're building a solution or you're funding a solution that, that helps you break out of this external locus of control. Like, hey, I'm, I'm still in charge of my destiny, whether I'm an employee or whether I own my own practice.
And so that's, that's something I really like about it as well.
Junaid Kalia, MD:
So beautifully said. Actually, I'm going to convert this to Ed now. Ed, as a non clinician, if you want to become CIO of a hospital, there are so many ways to cut the threads.
How, how would you, if you go back on your life and then sort of think about decisions and most importantly, how would you approach It. If you were an 18 year old, 22 year old, someone. Yeah.
Edward Marx:
Trying to go down into the CIO path. Yeah. Well, for sure, like I said, you need whatever the industry is, but obviously we're healthcare. You, you need to understand it at a ground base level. So you need to take a position working in the lab, like working in radiology work like I did. I think that's a ground that gives you the foundation to truly understand coming at it from a pure tech perspective.
Because you got to have the heart like, what are you, what are we doing?
We're healing people, people, we're taking care of people. So it's always important to have that clinical basis. Not everyone can be a doctor. I wasn't a doctor. But there's other things you can do, like I'm sharing, that are not hard. Anyone can do them. And so I would even recommend, going in and out, in terms of your career.
Because you never want to be all about the tech, because that's not what we're about. You never want to be just clinician because you don't want to ignore the tech. But it's that person like yourselves that can bring the two together to ultimately save lives and care for people, in the worst times of their life.
Junaid Kalia, MD:
I'm going to ask two very specific questions.
You're going to just say very one, one line answers all three of you. Number one, are entrepreneurs born or built? Is this a genetic or an environmental factor?
That's number one. And then number two, my prediction is that primary care physician is going to go away. I don't know. 1, 1 year, 3 year, 5 year, 10 year because of AI, is going to go away. What is going to replace it? One line answers.
John Dayton, MD, MBA:
I think some people are born salesmen. I think some people are born problem solvers. But one of the reasons that I like the training is because anybody can learn best practices.
Anybody can learn ways to move ahead. I think that AI is going to enable them to increase and enhance their role. And what I mean by that is I think AI is going to allow them to kind of free up, all the administrative things that they're not getting paid for to go back and be the quarterback for patient care.
I think future practice is going to involve, your primary care doctor. I think everyone's going to have agentic AI tools, maybe a physician AI that's involved with their care. But I, I think AI is actually going to able to enhance their position rather than have it be eliminated.
Edward Marx:
So I'm going to take a hard stance. I won't be wishy-washy. You're born, you're born with certain traits to want, to lead, to invent, to, you know, you're born that way. And what about what's going to replace primary care once it's gone because of AI? What do you think is going to be the new model? Oh yeah, Agents all the way.
Yeah, perfect. Harvey
Harvey Castro, MD, MBA:
I have a whole talk on this actually it's actually both.
There's some genetic components where we actually do have some genes that push us to be entrepreneurs and our risk takers and whatnot. The environment totally environment will push you and there's tons of examples. And then the second question I actually am with John.
I call it the great shift. And in that great shift we're going to see different roles of how we practice medicine. And the primary care physicians will be able to start doing medicine in a different level because of AI.
Junaid Kalia, MD:
And I truly believe that we're going to see the primary care going to AI plus APP or physician extenders while physicians are going to move towards higher level of care and hopefully it will bring both better care and everything.
I'm so grateful to everyone, especially John for joining us, Harvey from Amazon and Ed.
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