We’re excited to share that Dr. Rishi Khakhkhar, Counsel’s second hire and a driving force since day one, has been promoted to Chief Medical Officer!

A practicing Emergency Medicine physician, Rishi has worn many hats at Counsel. From leading our Commercial team to scaling Clinical Ops and shaping the product roadmap, he has helped build the company from the ground up. Today, he continues to play a pivotal role in delivering high-quality, asynchronous care while bringing a physician’s voice into every major client conversation and product decision.

We sat down with Rishi to talk about his journey, what his new role means, and his advice for physicians seeking to break into the startup world.

Read on for the full conversation.

Congratulations, Rishi, on your promotion to Chief Medical Officer at Counsel! You’ve been with the team since the very beginning. Can you share what drew you to the company, and what made you believe in the vision?

Thanks! What drew me in was this rare convergence of timing, technology, and mission, as well as the chance to help shape it from the ground up.

AI felt like a once-in-a-generation shift, similar to mobile and cloud. But unlike those earlier shifts, healthcare didn’t have to be a decade late to the party. Too often, physicians are handed tools that weren’t built for us. Electronic health records are a perfect example: they weren’t designed by clinicians, and they ended up adding friction instead of enabling better care.

What excited me about Counsel was the chance to do things differently. We could design care models that are scalable, clinically sound, and deeply human because doctors would be at the center of building them.

The team really sealed it for me. Muthu and Justin were exactly the kind of people I wanted to build with: mission-driven, technically world-class, and grounded in the realities of care. It felt like the right team, the right idea, and the right time.

You’ve worn a lot of hats at Counsel, from Commercial to Product to Clinical. How has that shaped your perspective on where we’re headed?

One of the best parts about working at an early-stage company is that everyone rolls up their sleeves. You get to see how all teams come together to deliver care safely and responsibly. That cross-functional exposure creates empathy and alignment.

When clinicians understand commercial needs, and engineers understand clinical workflows, you build a company that speaks with one voice. That alignment keeps us rowing in the same direction, even as we grow.

Can you share a moment when your clinical background directly helped close a client?

A great example is our partnership with one of the largest urgent care clinic networks in the US where we provide peer-to-peer clinical decision support to their mid-level clinicians. Clinical partnerships like this one aren’t just business transactions. They’re deeply personal. When a provider organization brings us in, they’re giving us permission to help care for their patients. That’s a big deal, and trust is everything.

My background as a physician helped us earn that trust, not just with their leadership, but with their frontline providers. Just like patients trust their doctors, provider organizations need to feel that same confidence in our team. That means being transparent, surfacing issues early, and sharing our clinical reasoning.

We take the same approach internally. The relationship between provider and patient is built on trust, and we believe the relationship between two clinical teams should be, too.

You’ve been at the helm of scaling the Clinical org. What has been the most challenging and rewarding part of that growth?

Creating community in a distributed, asynchronous medical group has been both the challenge and the reward.

In traditional settings, you have hallway conversations and residency lounges. We’ve worked hard to recreate that virtually through shared Slack channels, case reviews, and informal discussions. What has been even more rewarding at Counsel is that unlike traditional hospital settings where core clinical units are divided by specialty, our integrated clinical team is made up of a range of specialties and backgrounds. This allows us to learn from each other, but also provide the right type of care to our diverse population of patients that can be a rural chronic condition patient in a medical desert to the longevity-focused patient working in tech.

We also make it a priority to avoid the transactional feel that often comes with telemedicine. That starts with how we treat our physicians: not as widgets clicking boxes, but as professionals with deep expertise and clinical judgment.

What’s a piece of the product roadmap that you’re most excited about?

I think about our product roadmap in two buckets.

The first is using AI to reduce the cognitive burden on clinicians: automating chart reviews, streamlining intake, and accelerating decision support. These are the kinds of behind-the-scenes tools that make doctors faster and more efficient without sacrificing quality.

The second bucket is more ambitious: creating entirely new clinical experiences that weren’t possible before. One example is wearable data. For years, patients have wanted to bring their health data (steps, heart rate, and sleep patterns) to their doctors. But the tools weren’t there. Now, with the right tech stack and models, we can interpret that data in real-time and actually act on it. It’s a new way of delivering care that feels both more personal and more powerful.

You’re still a practicing Emergency Medicine physician at Mount Sinai. How did you decide to pursue both your clinical career and build a company? How do you balance the two?

Before Counsel, I ran virtual urgent care at Mount Sinai, which gave me a strong foundation in delivering care at scale. That experience, combined with my clinical training, made joining Counsel feel like a natural next step.

Seeing patients in-person reminds you of the human side of care, like what it feels like to hold someone’s hand, hear their tone, and make decisions in real-time. The best virtual care knows when to hand off to in-person care, and how to complement it.

At Counsel, we encourage our doctors to maintain in-person clinical practice if they want to. For me, it’s how I stay close to the full spectrum of care.

What advice would you give to physicians thinking about joining or building a startup?

Don’t underestimate the value you bring.

Most physicians today are employed, and over time, we’ve lost some of the agency and autonomy we used to have. But it wasn’t always this way. Not long ago, many doctors worked in independent or democratic groups and had enormous influence over how they cared for patients.

While we probably won’t go back to that model, startups offer a new version of that autonomy. The incentives are different, the tools are different, but the opportunity to shape care at a systems level is real.

Even if you’re not in a formal leadership role, the right startup will value your voice. And the work you do can shape not just how care is delivered, but who gets access to it.