A conversation with Douglas Flora, MD, LSSBB — Executive Medical Director of Oncology Services, St. Elizabeth Cancer Center; Author, Rebooting Cancer Care
Cancer care is groaning under its own weight.
That’s not a provocation. It’s the diagnosis Dr. Doug Flora lays out in his book Rebooting Cancer Care — and in this conversation with Reimagine Care Medical Director Dr. Pallav Mehta.
144,000 new oncology articles indexed on PubMed last year. Nearly 19 million cancer survivors in the U.S. today. A projected shortage of 14,000 oncologists and 1 million nurses by 2030. The number of cancer patients expected to double in the same period.
The system wasn’t designed for this. And the physicians inside it are burning out.
This episode is about what it actually looks like to reboot — replacing the mundane with the humane, using AI to give clinicians back the time and presence that made them want to practice medicine in the first place.
“Oncologists should be leaning into this because our primary goal in life is to ease suffering and care for their burden. If these technologies can remove two or three hours of the mundane — letting you be the doctor you swore you were going to be when you were a third year med student — the patients win. The nurses win. The doctors win.”
— Douglas Flora, MD, Author of Rebooting Cancer Care
What this episode covers
The case for rebooting Dr. Flora argues that oncology is running on a 1995 operating system — conservative by nature, slow to adopt, and overwhelmed by the volume and complexity of modern cancer care. AI isn’t a threat to that system. It’s the reboot it needs.
Where AI is already working today From ambient documentation that generates notes while clinicians stay present with patients, to image recognition software that catches lung cancer nodules and cardiac calcifications between visits, to pharmacogenomics alerts that prevent dosing errors — these tools aren’t coming. They’re here. The gap is awareness and adoption.
The burnout problem and who’s responsible for solving it Oncology went from being ranked 28th in physician burnout to tied for second — in roughly a decade. Dr. Flora is direct about why: the work has become transactional, the documentation has become unbearable, and the system asks clinicians to do thirteen hours of work in a twelve-hour day, every day. AI can change that math — but only if it’s designed with clinicians, not just for them.
What builders are getting wrong More clicks are bad. Tools that interrupt clinical flow fail. Pitching solutions that don’t solve the right problems wastes everyone’s time. Dr. Flora’s message to companies building for oncology: get physicians in the room from day one, and ask them what they actually want — not what you think they want.
The 21-day problem Giving a patient chemotherapy and checking back in three weeks later isn’t a care model. It’s a gap. Dr. Flora describes what continuous monitoring between visits could look like — and why tools like Remi represent the kind of infrastructure that makes 21-day intervals obsolete.
A bold look forward By 2030, AI will be table stakes for clinical trial screening. Within five years, drug discovery will move from wet benches to digital twins. And Dr. Flora’s closing claim: in patients with access to screening, stage three and four cancers could be eliminated by 2050.
About the guests
Pallav Mehta, MD — Host Dr. Mehta is a medical oncologist specializing in breast cancer and the Medical Director of Reimagine Care. He practices at MD Anderson Cancer Center at Cooper and serves as an assistant professor of medicine at Cooper Medical School. He brings nearly 20 years of clinical experience to his work at the intersection of oncology and virtual care.
Douglas Flora, MD, LSSBB — Guest Dr. Flora is the Executive Medical Director of Oncology Services at St. Elizabeth Cancer Center near Cincinnati, Ohio, where he has spent over two decades building and scaling cancer programs. He is the founder of the journal AI in Precision Oncology, a prolific writer on Substack on AI and cancer care, and the author of Rebooting Cancer Care — a clinician’s guide to using technology to restore the humanity of oncology practice. He speaks nationally on AI adoption, physician burnout, and the future of cancer care delivery.
How Reimagine Care fits the model Dr. Flora describes
Dr. Flora articulates the problem precisely: oncology care happens in isolated point-to-point visits, while the complexity of modern treatment demands something continuous. Tools that meet patients where they are, that surface what’s happening in the 21 days between visits, and that protect clinicians from after-hours calls and preventable ED escalations — that’s not a future state. That’s what Reimagine Care delivers today.
Dr. Flora put it directly in the conversation: tools like Remi are helping deliver care for the 21 days in between. As a physician, he described it this way — knowing a patient is hurting on day 10 of a xeloda cycle, so you can stop the drug before four more days of toxicity accumulate, rather than finding out on day 21 when it’s already grade three. As an administrator, the calculus is equally clear: preventing an expensive hospitalization before it becomes a life-threatening infection and an eight-hour ER visit.
What Reimagine Care provides:
- 24/7 oncology-trained clinicians available via text, phone, and video
- Remi — an AI-powered virtual assistant built specifically for oncology, not adapted from general-purpose tools
- Automated patient check-ins and ePRO collection between visits
- Connected device monitoring — temperature, blood pressure, pulse oximetry
- Real-time clinical dashboards so care teams know what’s happening before the next appointment
- AI designed with human-in-the-loop clinical oversight at every step — physician-led, HIPAA-aligned, fully auditable
AI supports scale. Humans own care.
Ready to replace the mundane with the humane in your program?
Whether you’re evaluating AI tools for symptom management, looking to reduce avoidable utilization, or building the infrastructure to extend your clinical team between visits — we’d welcome the conversation.
More from the Treating Together series
This is part of a four-part series featuring Dr. Pallav Mehta on Targeted Oncology’s Treating Together podcast.
- Part 1: Community Oncology at a Crossroads — with Debra Patt, MD
- Part 2: Precision Hope: The New Frontier of AI-Driven Oncology — with Douglas Flora, MD (
- Part 3: Beyond the Hospital Walls — with Jorge Garcia, PharmD
- Part 4: Leveraging AI, Social Media, and Virtual Care — with Sanjay Juneja, MD