Dr. Raj Narula is a vascular neurologist who walked away from a neurointerventional radiology fellowship to build something that could reach thousands of patients instead of one at a time.

Dr. Melanie Winningham is a vascular neurologist, medical director of a comprehensive stroke center in Virginia, and VP of Clinical Strategy at Sevaro- someone who has lived the neurology access gap from both sides of it.

In this episode of How I Doctor, Dr. Graham Walker sits down with Raj and Melanie to explore one of the most urgent and most invisible crises in American healthcare.

What happens when a stroke patient lands in a rural ER at 2 AM and the nearest neurologist is a hundred miles away?

For too long, geography has been the single biggest predictor of whether that patient walks out of the hospital. Sevaro was built to change that. This episode gets into what telestroke actually looks like when it's done right. They explain how Sevaro's AI-enabled platform — built by neurologists, for neurologists — puts a board-certified specialist on screen in 45 seconds, eliminates the call center entirely, and follows patients from the acute encounter all the way through rehab and outpatient care.

This isn't a pitch for virtual care. It's a clinician's diagnosis of a workforce crisis that isn't getting better and a concrete look at what it takes to build technology that works the way physicians actually practice.

If stroke outcomes are going to improve in rural America, it won't be through more neurologists. It will be through smarter infrastructure that makes the ones we have go further.

What You'll Learn

Why geography remains the single biggest predictor of stroke outcomes and what it actually takes to close that gap at scale.
How Sevaro eliminated the call center entirely and why that single design decision changes everything about the speed and quality of a telestroke consult.
What AI is doing inside an acute stroke encounter and where Raj and Melanie draw a hard line between decision support and decision making.
Why the neurology workforce crisis is structural and worsening, and how virtual neurology is reshaping who enters the field and why.
How keeping patients in their own communities creates a trust loop that improves outcomes over time.
Why state licensing requirements are the single regulatory change that would do the most to expand virtual specialty access in rural America.

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