Shiv Rao, MD

Building @AbridgeHQ + random musings at intersection of Warp records, late 90s skateboarding, Vincent Van Duysen, and cardiology.

[Abridge @AbridgeHQ]

Abridge moves at the speed of trust—with our health system partners, clinician users, and patients. Today, we’re moving further, faster than ever before.

Abridge Keynote
June 11
12PM EDT

[Shiv Rao, MD @ShivdevRao]

June 11. 12PM EDT.
Abridge Keynote.

RSVP for the livestream here: https://t.co/15syNUFNAo

[Shiv Rao, MD @ShivdevRao]

So much fun to sit down with @HarryStebbings on @twentyminutevc this week.

The time flew by, I learned a lot just from being on the other side of the conversation.

We talked about agent-native companies and Conway’s Law, why healthcare GTMs are often counterintuitive, and why Costco is a source of inspiration.

Grateful to you, Harry 🙏.

[Harry Stebbings @HarryStebbings]

I have interviewed 1,000s of the world's best founders over the past decade. Few have impressed me like @ShivdevRao at @AbridgeHQ.

He navigated a brutal 5-year wilderness before exploding into one of the most dominant forces in vertical AI.

Today, Abridge is a $5.3BN powerhouse.

I sat down with Shiv to unpack exactly how he did it and condensed my notes below:

🚀 6 Lessons on Building a $5.3B Vertical AI Juggernaut

1. Survive Long Enough for Market Timing to Catch Up:

Abridge spent 5 years in the "wilderness" before hitting a tidal wave of adoption. When you have an absolute true north thesis, your primary job in the early days is simple: stay standing and don’t die. You must be alive when the sky finally opens up.

2. Pivot the Product, Never the Core Thesis:

Shiv was willing to pivot on features, go-to-market strategies, and business models. But he refused to budge on his core thesis that healthcare is ultimately powered by the spoken human signal. Die on the hill of your thesis; adapt everything else.

3. Target the Concentration of Scale Early:

A massive trap for healthcare and enterprise founders is staying down-market too long for "fast feedback loops". In the US, the vast majority of clinicians are concentrated within large, integrated delivery networks. Time your "YOLO shot" to go up-market the moment the market inflects.

Single biggest advice to founders on when to go up market @bhalligan @dharmesh?

4. Own Your Stack to Protect Your P&L and UX:

While many AI startups rely entirely on frontier systems, 40% of Abridge's model outputs are generated by in-house models. Milliseconds matter in high-stakes enterprise workflows. Building your own models gives you insane performance gains, lower latency, and ultimate control over your P&L.

When should you vs should you not build your own model @matanSF @MaxJunestrand @antonosika?

5. Don't Fight Foundation Models—Counter-Position Instead

If you try to fight the frontier model giants directly, you've already lost. You win by going millions of miles deep into regulated industries with proprietary datasets and workflows they can't easily replicate. Find ways to coexist and leverage their tailwinds.

Reminds me of what @bradlightcap said on his 20VC.

6. Move Toward the "Flat Company" Era:

With the explosion of AI agents and advanced tooling, the traditional management layer is compressing. Shiv’s latest idealistic shift is building a hyper-flat organization: fewer managers, and highly leverageable "Super ICs" who can move in lockstep and cover massive surface area.

(link in comments)

[Chaitanya Asawa @c_asawa]

Really fun conversation with @swyx and @jacobeffron. AI in Healthcare can have tremendous impact, yet I find many may not be aware on technical problems in the field. I can tell you, as we cover in this podcast, there are so many frontier technical opportunities in a large and greenfield industry!

[Latent.Space @latentspacepod]

Abridge: 100M+ medical conversations, real-time prior auth, and the clinical intelligence layer https://t.co/Rzl4CL9w9a

@AbridgeHQ is building the clinical intelligence layer for healthcare. In this episode, Janie Lee and @c_asawa explain why ambient documentation was only the first wedge, how Abridge is turning patient conversations into real-time clinical decision support, why healthcare may become one of AI’s most important proving grounds, and how 100M+ medical conversations, specialty-specific evals, and deep EHR integrations create a moat for AI-native healthcare.

[Tuhin Srivastava @tuhinone]

https://t.co/YPONx4IZSz

[Shiv Rao, MD @ShivdevRao]

Read more:
https://t.co/hWPaaC1ri0

[Shiv Rao, MD @ShivdevRao]

Nursing documentation is fundamentally different. It lives across flowsheets: assessments, vitals, mobility, pain, safety, I&O. Structured, continuous, bedside.

With our new nursing flowsheet architecture + GPT-5.4, Abridge is drafting ~30–40% more fields from the bedside conversation for nurse review. The unlock isn't capture. It's context. Grateful to our team and also partners at @OpenAI.

[Newcomer @NewcomerMedia]

There are journeys where we'll still want humans in the loop, says @ShivdevRao of @AbridgeHQ at Cerebral Valley Voice.

And the most human signal is spoken.

[Nikhil Krishnan @nikillinit]

me and @jacobeffron had a 2 on 2 with @ShivdevRao and @mnedoszytko about a lot of things - but one was whether doctors will build their own tools vs. use third parties

I think it's an interesting question even I go back and forth on. IMO doctors are excellent at understanding where to point automation because they know where the repetitive flows are. This is going to be an excellent place for them to prototype tools that a design partner can bring to life.

But trying to rethink a process end-to-end with AI at the core is much more difficult. It requires not only a physician partner, but one who deeply understands what technology is capable of/limited by today AND who's thought of each part of the care journey from first principles.

A tangible example of this is the difference between creating a tool that can make a better patient intake form vs. someone who thinks about how the patient intake form fits into triaging -> how they're routed to telemedicine (async or not) and in-person -> what the inventory requirements of the office are if you see different types of patients -> what contracting model makes the most sense and are you getting the info you need through this process to get paid.

We had a longer discussion about the different archetypes of physicians in the full pod

[Shiv Rao, MD @ShivdevRao]

Welcome @mnedoszytko Nedoszytko, cardiologist turned Anthropic hackathon winner, to @AbridgeHQ .

A few weeks back, Michał built a platform to support patients after they leave the doctor’s office, a powerful example of clinicians stepping up to build the tools they actually need.

We sat down with @jacobeffron Effron and @nikillinit Krishnan to talk about our shared mission to reshape healthcare with AI.

From the moment I saw his hackathon project, it was clear he gets it. Clinicians are not just using AI anymore, they are shaping the future of medicine.

[Shiv Rao, MD @ShivdevRao]

@mnedoszytko @AbridgeHQ Listen here: https://t.co/41fnKnC0y2

[Jacob Effron @jacobeffron]

A few months ago, @mnedoszytko placed 3rd out of 13,000 in Anthropic's hackathon. He was a Head of Cardiology in Brussels at the time. Now he's at @AbridgeHQ.

New Vital Signs where @nikillinit and I sit down with Michal and Abridge CEO @ShivdevRao to discuss:

- How clinical practice is changing in the age of AI
- The future of AI in healthcare
- What med schools need to start teaching now

Super fun episode. Check it out:

YouTube: https://t.co/VJMG4KGp8C
Spotify: https://t.co/7svZLlJAkG
Apple: https://t.co/jVgkvT7AbQ

[Shiv Rao, MD @ShivdevRao]

GPT-5.5 early access results have been impressive.

25% lift in clinical quality.
30% less verbose.

We orchestrate hundreds of AI tasks, some powered by our proprietary data flywheels, others by frontier models like GPT-5.5.

We test rigorously for clinical accuracy, completeness, reasoning, real-world because benchmarking is a big deal in healthcare.

Grateful to the OpenAI team for the early access and partnership.

[Abridge @AbridgeHQ]

Early Impact Results from GPT-5.5

We’ve been evaluating @OpenAI’s newest model across Abridge workflows like note generation and clinical decision support. In healthcare AI, it’s not one model, it’s orchestration. Every model is rigorously tested before use.

The results include a relative 25% lift in clinical quality coverage and 30% more concise responses.

[Abridge @AbridgeHQ]

What’s it like building at Abridge? “It feels like the beginning of the Internet… It’s love for software that I have never seen.”

Watch to see what our builders say about working at Abridge.

We’re fortunate to be backed by investors who share our vision, including @a16z @eladgil @khoslaventures @NVIDIA Ventures @IVP @SVAngel @lightspeedvp @Redpoint @sparkcapital @BessemerVP @usv

We’re hiring in SF!

[Abridge @AbridgeHQ]

Abridge named #3 in the AI category on @FastCompany���s 2026 Most Innovative Companies list—alongside Google and Anthropic.

This recognition reflects the impact of AI at scale across our 250+ health system partners, and the work of the Abridge team building cutting-edge technology to solve some of healthcare’s hardest challenges.

The recognition is nice. The work is better. Join us, we're hiring :)

[Shiv Rao, MD @ShivdevRao]

@EthanChoi7 @AbridgeHQ 🙏 I'm lucky to work with you, Ethan!

[Shiv Rao, MD @ShivdevRao]

@morgancheatham @AbridgeHQ 🫀

[Shiv Rao, MD @ShivdevRao]

If you’re wondering what this looks like from the inside.

Hiring in SF.

[Abridge @AbridgeHQ]

What’s it like building at Abridge? “It feels like the beginning of the Internet… It’s love for software that I have never seen.”

Watch to see what our builders say about working at Abridge.

We’re fortunate to be backed by investors who share our vision, including @a16z @eladgil @khoslaventures @NVIDIA Ventures @IVP @SVAngel @lightspeedvp @Redpoint @sparkcapital @BessemerVP @usv

We’re hiring in SF!