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Brian Hudes, MD

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Brian Hudes, MD

A board-certified gastroenterologist and hepatologist with more than thirty years of clinical experience.

30 articles on KevinMD · 1 podcast episode

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About

Brian Hudes is a board-certified gastroenterologist and hepatologist with more than thirty years of clinical experience and a recipient of his specialty board's thirty-year certification award. He built and ran a private gastroenterology practice for twenty years, then spent more than a decade in hospital-based gastroenterology, most recently as chief of gastroenterology and medical director of GI and endoscopy at a 550-bed Level I trauma center in Pensacola, Florida. He is an assistant professor of medicine at Florida State University College of Medicine.

Those two halves of a career shape the way he writes about medicine and clinical technology. Outpatient practice and hospital-based care fail their clinicians differently, and many systems are designed without a meaningful understanding of both environments.

Dr. Hudes has been building clinical software alongside his medical practice for decades. In 1995, during his gastroenterology fellowship, he co-developed one of the first Windows-based endoscopy reporting systems in the United States. He is now founder and chief executive officer of AiMOS Systems Corporation, where he is developing an AI-native clinical platform for outpatient and hospital-based care. AiMOS has been accepted into NVIDIA's Inception program.

He writes about the architecture of clinical information, administrative cost growth, physician workforce shortages, board certification policy, and the widening gap between what clinicians need and what the health care technology industry builds. He also publishes The Renaissance Physician, an independent publication examining medicine, technology, physician workforce, and the structure of modern clinical practice.

On The Podcast by KevinMD

Latest articles

Health technology

How much time do AI scribes really save physicians?

Doctors report feeling better with AI scribes. The measured time savings are smaller than many of them perceive, and the work of checking the AI is still unpriced. In a 2026 study of 252 physicians in the American Journal of…

Doctors report feeling better with AI scribes. The measured time savings are smaller than many of them perceive, and the work of checking the AI is still unpriced.

In a 2026 study of 252 physicians in the American Journal of Managed Care, 86.5 percent said an AI scribe reduced their documentation time. The authors also measured documentation time directly. They found no significant association between the change a physician perceived and …

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How much time do AI scribes really save physicians?

Health technology

AI medical devices and the check nobody pays for

Medical AI is deployed on the assumption that a clinician will review its work. I found no payer that prices the review. The Food and Drug Administration (FDA) has now cleared 1,614 AI-enabled medical devices. By analyst Chi-way Li's count,…

Medical AI is deployed on the assumption that a clinician will review its work. I found no payer that prices the review.

The Food and Drug Administration (FDA) has now cleared 1,614 AI-enabled medical devices. By analyst Chi-way Li’s count, at least 79 have payment of their own; most of the rest are bought from hospital budgets or ride inside tests insurers already cover. Yet whenever an AI read, note, or …

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AI medical devices and the check nobody pays for

Health policy

Surgery center profit margins were highest at nonprofits

A research letter published in JAMA Health Forum on September 25, 2026, examined the 2024 financial reports of 257 ambulatory surgery centers (ASCs) in Pennsylvania. The finding was not what the usual debate over outpatient medicine would lead you to…

A research letter published in JAMA Health Forum on September 25, 2026, examined the 2024 financial reports of 257 ambulatory surgery centers (ASCs) in Pennsylvania. The finding was not what the usual debate over outpatient medicine would lead you to expect.

Nonprofit centers represented 20.6 percent of the facilities. They collected 35.8 percent of the revenue and earned 51.5 percent of the net income. Their median profit margin was 37.8 percent. …

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Surgery center profit margins were highest at nonprofits

Health technology

Judge AI in health care by its worst answer, not its best

Health care's AI conversation is moving from documentation to decision. The pitch, repeated across the industry, is that we should stop using AI merely to write our notes and start using it to improve the decisions those notes record: to…

Health care’s AI conversation is moving from documentation to decision. The pitch, repeated across the industry, is that we should stop using AI merely to write our notes and start using it to improve the decisions those notes record: to surface risks, close care gaps, and deliver “actionable intelligence” inside the workflow. The ambition is reasonable. But it quietly raises the stakes on a problem the documentation era let us …

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Judge AI in health care by its worst answer, not its best

Health technology

Clinical AI accountability does not come with your EHR

In a recent essay on Epic and Oracle, Eric Doherty argued that health care leaders should not pick a side. They should demand AI that is trustworthy, portable, and patient-centered. I agree. But that is the beginning of the accountability…

In a recent essay on Epic and Oracle, Eric Doherty argued that health care leaders should not pick a side. They should demand AI that is trustworthy, portable, and patient-centered. I agree.

But that is the beginning of the accountability question, not the end. Once the technology is in use (drafting the note, suggesting the code, proposing the order, flagging the patient), who verifies that it keeps performing as expected? Who …

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Clinical AI accountability does not come with your EHR

Health technology

AI isn’t going rogue. Clinical AI has a quieter danger.

The headlines have a rhythm to them now. Artificial intelligence is "going rogue" (lying, cheating, hacking, scheming to preserve itself), and the next model may be powerful enough, in Bill Gates's phrase, to cause a billion deaths. For those of…

The headlines have a rhythm to them now. Artificial intelligence is “going rogue” (lying, cheating, hacking, scheming to preserve itself), and the next model may be powerful enough, in Bill Gates’s phrase, to cause a billion deaths. For those of us watching AI arrive in our clinics and hospitals at the very same moment, it is a strange dissonance: We are being told to adopt a technology and to fear …

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AI isn’t going rogue. Clinical AI has a quieter danger.

Health technology

Administrative bloat in hospitals is a design choice

The secretary who became fifteen executives' assistant A patient of mine spent his career as an executive at a large consumer-products company. When he started in the early 1980s, every executive had a secretary. Letters were typed and mailed. Travel…

The secretary who became fifteen executives’ assistant

A patient of mine spent his career as an executive at a large consumer-products company. When he started in the early 1980s, every executive had a secretary. Letters were typed and mailed. Travel went through an agency. Over the next twenty years, email replaced the mail, voice recognition replaced the typist, and a website replaced the travel agent. By the time he retired, one …

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Administrative bloat in hospitals is a design choice

Health policy

Private equity in medicine did not kill private practice

On September 16, Senators Warren, Wyden, and Merkley, with Representatives Ocasio-Cortez, Hoyle, and Subramanyam, introduced the Stop Corporate Takeovers of Physicians Act. Modeled on an Oregon law that took effect this year, it would bar private equity funds, insurers, and…

On September 16, Senators Warren, Wyden, and Merkley, with Representatives Ocasio-Cortez, Hoyle, and Subramanyam, introduced the Stop Corporate Takeovers of Physicians Act. Modeled on an Oregon law that took effect this year, it would bar private equity funds, insurers, and other for-profit corporations from owning or controlling medical practices, close the friendly-physician loophole, and limit restrictive covenants. Most physicians will like most of what is in it. I do.

But …

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Private equity in medicine did not kill private practice

Health technology

Why clinical AI limitations are not a physician problem

The most consistent advice physicians receive about clinical AI is that we should be more careful with it. Verify the output. Treat it as a draft. Structure the input. Build verification into practice as the defining skill of the coming…

The most consistent advice physicians receive about clinical AI is that we should be more careful with it. Verify the output. Treat it as a draft. Structure the input. Build verification into practice as the defining skill of the coming decade.

All of this is good counsel. None of it addresses the problem the same authors have already correctly identified.

Harvey Castro made the diagnosis on this site in May 2025, …

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Why clinical AI limitations are not a physician problem

Health technology

Why prompt engineering for physicians fails at 2 a.m.

Vinson James has found something that deserves more attention than it will get. Testing six large language models on validated pediatric board questions, he reports that accuracy ranged from 38 to 90 percent when the questions were delivered all at…

Vinson James has found something that deserves more attention than it will get. Testing six large language models on validated pediatric board questions, he reports that accuracy ranged from 38 to 90 percent when the questions were delivered all at once, and converged to 83 to 88 percent when the same questions were delivered in batches of ten. Identical questions. Identical models. The only thing that changed was how the …

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Why prompt engineering for physicians fails at 2 a.m.

Health technology

Clinical AI cannot reason over a billing document

Two good arguments about clinical AI have appeared here recently, and between them they have accounted for almost everything except the part that matters most. Harvey Castro has argued that the real limitation is not the model but the context,…

Two good arguments about clinical AI have appeared here recently, and between them they have accounted for almost everything except the part that matters most.

Harvey Castro has argued that the real limitation is not the model but the context, pointing to the blood pressure entered three minutes ago and the allergy buried in yesterday’s note that the system cannot see. Miguel Venereo has argued that the record itself is fragmented, …

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Clinical AI cannot reason over a billing document

Health technology

AI was the chief resident for my physician job search

Physicians are trained to manage complexity under time pressure. We carry twenty patients, track a dozen pending studies, remember which consultant owes us a callback, and keep it straight. Then we go looking for a job and manage the whole…

Physicians are trained to manage complexity under time pressure. We carry twenty patients, track a dozen pending studies, remember which consultant owes us a callback, and keep it straight. Then we go looking for a job and manage the whole thing out of an inbox and a legal pad.

A hospital-employed position search generates a startling volume of material: recruiter emails, competing time zones, credentialing packets, site visit logistics, contract drafts …

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AI was the chief resident for my physician job search

Health policy

The corporatization of medicine, in salaries and beds

In the 1970s, the American hospital was, in the industry's own language, an "open workshop." A physician kept an office down the street, admitted patients to the hospital when they needed a bed or an operating room, and worked largely…

In the 1970s, the American hospital was, in the industry’s own language, an “open workshop.” A physician kept an office down the street, admitted patients to the hospital when they needed a bed or an operating room, and worked largely independent of whoever managed the building. The doctor made the medical decisions; the administrator kept the lights on and the ledgers balanced. It was an arrangement with obvious flaws (fragmentation, …

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The corporatization of medicine, in salaries and beds

Health technology

The case for an AI-native health care platform

From 1992 to 1995 I was a GI fellow. Nothing on the market made clinical sense for endoscopy reporting. The tools available were designed by people who had apparently never performed a procedure or written a note for one. I…

From 1992 to 1995 I was a GI fellow. Nothing on the market made clinical sense for endoscopy reporting. The tools available were designed by people who had apparently never performed a procedure or written a note for one. I met a colleague in Australia, and together we built one of the first Windows-based endoscopy reporting systems in the country.

Microsoft Access. It worked.

It worked well until the United States moved …

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The case for an AI-native health care platform

Health technology

How artificial intelligence documentation hurts patients

If you have spent any time with the current generation of artificial intelligence (AI)-assisted documentation tools, you have probably noticed something that is difficult to articulate but impossible to ignore. The notes they produce are correct, grammatically, structurally, and medically,…

If you have spent any time with the current generation of artificial intelligence (AI)-assisted documentation tools, you have probably noticed something that is difficult to articulate but impossible to ignore. The notes they produce are correct, grammatically, structurally, and medically, and yet they feel wrong. They read like a summary written by someone who has read every clinical textbook ever published but has never stood at a bedside at 2 …

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How artificial intelligence documentation hurts patients

Health technology

Severe note bloat is fueling dangerous physician burnout

You open the chart. You start clicking. Labs here. Imaging there. Notes in four different tabs, none of them organized in any order a clinician would have chosen. Prior hospitalizations buried three levels down behind a menu that requires two…

You open the chart. You start clicking. Labs here. Imaging there. Notes in four different tabs, none of them organized in any order a clinician would have chosen. Prior hospitalizations buried three levels down behind a menu that requires two clicks just to find the menu. Medication reconciliation on a screen you have to navigate to separately. Problem list in one place, active diagnoses in another, allergies somewhere a third …

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Severe note bloat is fueling dangerous physician burnout

Physician voices

How board certification fuels the physician shortage crisis

2

For years, the conversation about board certification has centered on fairness, cost, and evidence. But there is another consequence that gets far less attention: how these systems affect the supply of practicing physicians. America's physician shortage isn't theoretical anymore. It…

For years, the conversation about board certification has centered on fairness, cost, and evidence. But there is another consequence that gets far less attention: how these systems affect the supply of practicing physicians.

America’s physician shortage isn’t theoretical anymore. It is here. Hospitals are scrambling to fill call schedules, rural communities are waiting months for specialist appointments, and medical groups are watching senior clinicians retire earlier than planned. Among the many …

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How board certification fuels the physician shortage crisis

Physician voices

Why maintenance of certification varies widely: a system in crisis

If you asked ten physicians to explain how they maintain board certification, you’d get at least ten different answers, maybe more. Some take quarterly quizzes. Some submit CME attestations every five years. Some do both. Others, grandfathered in before time-limited…

If you asked ten physicians to explain how they maintain board certification, you’d get at least ten different answers, maybe more. Some take quarterly quizzes. Some submit CME attestations every five years. Some do both. Others, grandfathered in before time-limited certification existed, do nothing at all. Yet every one of them carries the same professional label: board-certified physician.

That simple title, once synonymous with competence, now hides a dizzying patchwork of …

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Why maintenance of certification varies widely: a system in crisis

Physician voices

MOC patient outcomes: Why recertification doesn’t guarantee quality

Every major policy in medicine is supposed to rest on evidence. We track outcomes for new drugs, devices, and procedures. We measure hospital mortality, infection rates, and adherence to guidelines. Yet one of the most time-consuming and expensive physician policies…

Every major policy in medicine is supposed to rest on evidence. We track outcomes for new drugs, devices, and procedures. We measure hospital mortality, infection rates, and adherence to guidelines. Yet one of the most time-consuming and expensive physician policies of all, Maintenance of Certification (MOC), has never been held to that same standard.

For decades, the American Board of Internal Medicine (ABIM) and other specialty boards have argued that recertification …

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MOC patient outcomes: Why recertification doesn’t guarantee quality

Physician voices

The American Board of Internal Medicine maintenance of certification lawsuit: What physicians need to know

2

Editor's note (2026): The Association of American Physicians and Surgeons Educational Foundation lawsuit against the American Board of Internal Medicine alleges that certifying boards threatened physicians' certification over their public statements on COVID-19 and abortion; it does not challenge maintenance…

Editor’s note (2026): The Association of American Physicians and Surgeons Educational Foundation lawsuit against the American Board of Internal Medicine alleges that certifying boards threatened physicians’ certification over their public statements on COVID-19 and abortion; it does not challenge maintenance of certification as an illegal tie. A federal judge dismissed the case in May 2023, the 5th U.S. Circuit Court of Appeals revived it in June 2024, the judge dismissed …

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The American Board of Internal Medicine maintenance of certification lawsuit: What physicians need to know

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