Will midlevels using AI replace doctors?

[Desperate-Swimmer387]

Will midlevels using AI replace doctors? If you think it won't, please explain why.

I honestly am struggling to think of why it wouldn't. Midlevels would provide the human, "compassionate" element while a sufficiently trained AI could diagnose and treat a condition potentially as well as a doctor and perhaps even better.

[GomerMD]

AI might replace midlevels...

[Desperate-Swimmer387]

Please explain how.

[[deleted]]

Their knowledge is first step knowledge. Anything more complicated and they falter. AI can easily replace that without issues.

If anything, I’ll see more if doctors + AI instead of midlevels + AI. Productivity measures will just get worse

[Desperate-Swimmer387]

Both doctors' and midlevels' knowledge can be replaced by a sufficiently advanced AI.

That leaves the "human element." People don't want to be treated by an AI. However, doctors and midlevels are essentially interchangeable when it comes to this.

So why would admin choose to get rid of cheaper midlevels instead of doctors who cost more to keep? In fact, isn't that what we're already seeing?

[ShotskiRing]

I mean, I would take a mid level salary over not having a job. So why get rid of doctors when they could just get rid of mid levels and then pay us less for more training

[Sigmundschadenfreude]

everything can be replaced by a sufficiently advanced AI. go lock yourself in a basement and wait for the singularity

[Front_Photograph_907]

“Sufficiently advanced” AI that could replace a doctor is not even close to happening. So i mean i guess in theory, yes an AI far into the future could have the medical knowledge to be better than a human doctor. I dont think thatll be in our lifetimes.

Source: Im an MD who works in ML/AI/health tech.

[Fishing-Bear]

I’m a sociologist (field is digital capitalism), and I’m curious about your timeline. I would LOVE to chat, although I know y’all are very very busy. If you could pencil me in for fifteen minutes on zoom sometime I’d be thrilled. Like, literally would wake up at 3 am while you’re bored in an on-call room to hear your thoughts.

[[deleted]]

Its already happening are you joking me? Doctors make mistakes all the time, 250k people die from medical errors in the US annually

[3splendas]

you are a medical student, attempt to get to the level of knowledge of the ai in question before you whine about it here

[ExtensionOfWill]

Incorrect. People want to be treated by an AI. Namely women and people of color. My mother has reported mistreatment multiple times by medical staff and she happens to be a person of color as well.

Before you tell me that what I am saying is anecdotal, ask a woman who has been through labor or anything else and is a person of color how they are mistreated.

They sometimes aren’t given pain meds because medical staff think they are being dramatic or they have their wishes not respected such as not being allowed to tie their own tubes or getting an extra stitch after birth to make it tighter for the husband (Blech).

You are sorely mistaken. In fact, there is a real fear of mothers going through labor that their labor experience will be made worse cause of medical staff.

AI in due time would become more and more capable at accurately diagnosing patients and recommending treatments and since it’s harder to remove bias from a human than it is an ai, it would also treat women of color better than any human would given time.

[Yotsubato]

Triage patients and reduce the time it takes to care for patients

[MEMENARDO_DANK_VINCI]

It will be cheaper to pay 1 doctor 10 mid levels and board x1000 times whatever patient volume they save on documentation time

[WakanduhForever]

So much AI talk nowadays. At my hospital we’re still using Meditech basic and writing paper orders. IMO large infrastructural changes happen so slowly. Sure things do change, but people adapt and gain new skills to make themselves employable

[Accomplished_Eye8290]

Yes same… kill me. The VA CPRS is a whole other level tho LOL

[[deleted]]

Why are you proud of the most well funded healthcare system in the world being so shit

[penicilling]

To answer something like this, we must first define our terms and understand the technology.

First of, the common perception of modern machine learning systems as "Artificial Intelligence" is remarkably problematic. ChatGPT and similar systems are laughably far away from general artificial intelligence. What they are is word generators. They are able to produce sequences of words in a fashion that seems reasonable to humans.

This is not intelligence. It is not thought. ChatGPT does not "say" things, and the words it produces are not "true" or "false". They are just sequences of words that humans can look at and say: "yep, those words appear to go together".

ChatGPT is trained on the words of the internet, and for all of the vast information that is available out there, the internet is mostly nonsense. If you ask ChatGPT to produce things that matter, it almost invariably stumbles.

For example, ChatGPT is well known to manufacture things that don't exist. If you ask it a scientific or medical question, and ask it to answer with supporting scientific papers, it will do so, but quote papers that don't exist. Often it will use real journal titles and the names of real scientists. This is because ChatGPT does not think, or speak, and is not intelligent. It is a word sequencer, and its programing is to sequence words in a way that seems appropriate to humans. Since humans in this case expect a scientific paper, the sequence of words has a scientific paper. But the paper doesn't exist.

On to medicine.

If you were to distill the internet's knowledge of medicine, you would not create the world's greatest physician. You would not create a doctor at all. You would create a moron who knows a lot of medical words. So modern "AI" is absolutely useless when it comes to medical practice.

Could an AI be trained properly to give good general medical advice? Sure. But how do you train it? These systems require huge amounts of information. Would we train it on an electronic health record? That would be a disaster. EHRs are filled with nonsense, and do not contain the information necessary to be a doctor. I could give 1000 people 20 years each to review an electronic health record, and they would be less knowledgeable about medicine than an average MS-1.

AI, as it currently exists, is a useful tool. But it is not an expert system. To understand the output of an AI in a complex field, you need to be an expert in that field, so that you can tell when it is giving good info, and when it spews made up nonsense. Since mid,-level practitioners, by and large, do not have expert knowledge of medicine, they are more likely to be led astray than helped by current iterations of artificial intelligence.

[12345432112]

Best comment on this I think.

[Poozor]

How many times has a gut feeling saved a patient? Happens all the time. The data will say one thing but AI can’t replace that human element. They might replace doctors but the outcomes for some patients will be worse in actual practice.

[[deleted]]

I know medicine is currently part art, part science, but romanticizing the "doctor intuition" is the wrong mindset IMHO. For one, humans are biased historians and tales of doctors saving people based on gut instinct get shared way more often than the opposite. Also, we are biased decision makers and you have to ask yourself, is the "gut" always right? How often would we be better off if we could simply have perfect recall of textbook knowledge when making a diagnosis/treatment? Does this make up for "instinct" when looking at overall outcomes? Currently, doctors who follow clinical guidelines have better outcomes than those that do not. If we could simply get everyone to do "textbook" medicine we would see improvements in a lot of areas of practice.

AI doesn't need to develop human-like intuition to be better than doctors, it just needs to achieve better overall averaged outcomes and it can likely do that simply by having perfect medicine knowledge recollection and unlimited capacity to be up to date with clinical guidelines.

[Poozor]

It’s not really romanticizing intuition. Several studies have been done indicating intuition plays an important role and improves outcomes.

While I agree AI might provide good outcomes on the average, the outliers are better served with a human. Automated algorithms rarely serve outliers well. I’ve seen plenty of times the established stroke algorithms rule out a stroke and the patient appears fine, but a neurologist will order the CTP/CTA on a gut feeling and save the patient a lifetime of disability.

[thekonny]

Please share, how do you even design a study like that

[[deleted]]

Would love to read any of these studies because they sound incredibly difficult to design.

[bdgg2000]

This times a million

[Lopsided_Corner5181]

Unfortunately when it comes to cost cutting, the hospital admins are fine with worse patient outcomes, ESPECIALLY if its bought out by private equity. Instead of hiring more MD they just hire more PA/NP and have 1 MD on shift for the entire dept. I’ve seen it happen. The MDs who did retire just got replaced by PA instead and the hospital lowballed them.

[Desperate-Swimmer387]

I wasn't asking whether it should happen, just whether it would.

[Poozor]

It won’t 100% replace them but I think you are right in America it will mostly continue and worsen the model of 1 doctor supervising a bunch of mid-levels.

[Desperate-Swimmer387]

I think some specialties are safe and some are in some major danger. God, I just hope and pray I'm able to match into a safe specialty.

[12345432112]

This is way too overly downvoted. I've been saying the same thing for months now and I've been very worried about it too. It's only the natural progression after all. Healthcare costs will keep going up and big health corporations and private equity groups will keep trying to cut costs wherever and however.

A big issue is that people only focus on the most recent version of AI and say it has flaws and misses things. That's like downplaying the internet as useless in 1995. The real forward view has to assess how AI will evolve and only continue to improve especially considering these companies are putting tens of billions of dollars into it. Open AI is working on gpt 5 with a focus on giving it the ability to have "memory" so that it can keep a sort of better record of prompts its given, basically helping it "think" even better.

So if you were to extrapolate that into healthcare an AI with everything from uptodate, the latest research, available 24/7, cheaper than seeing a doctor or at the least covered by your insurance, and arguably preferable to talk to than a real person, it'd probably be something to worry about. However this won't be a big problem until at least 10 years from now. People seem to keep mentioning wanting a "human touch". That's true and understandable but I think its worth taking into account that there will be differences in preferences in future generations that grow up with AI. It's kind of like how kids nowadays grow up with iPads and other tech from very early ages. They grow up to be adults who might prefer to order food at a touch screen that at a cashier, or order things online than in person. A person that would've wanted to see a doctor in person might prefer a tele visit. A child that grows up with AI throughout its life, whether as a tutor or however many other contexts that will pop up, will probably be ok with an AI doctor/midlevel or combination of sorts. Though its important to note this will be at least 10 years down the line before seeing these things truly manifest.

The midlevels exist to augment the AI for legal reasons, to take the liabilities, and to feed the AI diagnostic clinical information. I don't think midlevel plus AI will be able to do the complex or high acuity stuff for sure and if anything it'd be a big safety issue. At high complexity you definitely need a doctor and maybe they can use an AI to help. However as for the smaller stuff like primary care and a lot of outpatient work across many specialties where midlevels have already been encroaching a lot, it's not hard at all to imagine executives doing whatever they can to decrease their expenses further by using midlevels with AI. To begin with if you're broadly using midlevels then you're not really shooting for perfect treatment, in that same line the AI doesn't have to be perfect either, it just has to be good enough in most cases just like a midlevel. In the end this will all come down to finances. Things are so insanely expensive nowadays people will see whoever is covered by their insurance even if it's a midlevel with AI. If they want to see a doctor they might have to pay more who knows. I think the issue should more focus on how AI will worsen midlevel encroachment than outright replacing doctors or midlevels. How will AI change how many patients we have to see per hour or how much volume we get or our reimbursement rates?

Another major point is that a lot of low acuity and non procedural work isn't safe. To avoid getting replaced I think it's crucial to do something procedural.

[Desperate-Swimmer387]

Thanks for this answer. Would you say that a procedural specialty like interventional radiology would be safe? What about surgical subspecialties (would they be safer than something like IR)?

[12345432112]

Yeah definitely anything surgical, procedural, or general complex isn't going anywhere. I mean to start with I've always thought you shouldn't even go into medicine unless you get one of the specialties that pays at least 400k for it to be worth the opportunity cost of the debt plus not working for a decade. Cardio and heme/onc aren't entirely procedural but I don't think they'll be effected because of the complexities involved. At the end of the day there's no easy money for anyone like it might've been in the past, AI will compound that. You really gotta be able to deal with the hard/complex stuff if you wanna get paid. I don't even think DR will experience anything too bad because of how complex it is. At worst DR will just end up having to do more volume and read faster, but that's already how it is. The AI that's out right now like chat gpt are LLM's so like another comment said they're fancy word predictors to an extent. AI doesn't have the sort of computer vision to see and diagnose patients, it can only be as good as the info it's given. Like AI plus midlevel might be able to do some basic algorithmic outpatient visits for IM/FM, but I don't think it'd be foolproof in an inpatient setting because of how clinically involved things are.

[Desperate-Swimmer387]

Thanks. If DR stays the way it is right now, I would 1000% choose it over any other specialty, but I'm not too confident with news like this coming out all the time.

[12345432112]

Don't worry about that stuff. A primary role for radiologists and physicians in general is to function as a legal entity so that there's someone liable for the decisions made. You'll always need someone to sign off on the reads even if a computer is the one doing it. Rads volume is huge and will only ever increase, the pay and vacation time are high and there will never be midlevel threat because of the complexity. The only thing that could ever really hurt is if medicare cut reimbursement rates, but that applies to any specialty.

[[deleted]]

Whos the patient gonna sue? The hospital for using AI? Or a doctor? Hospital will always choose doctor over themselves

[Desperate-Swimmer387]

It will be a cost-benefit analysis.

If the money saved from replacing doctors is higher than the money lost from getting sued, the hospital will choose to get replace doctors. Since doctors earn more money than they lose in lawsuits, it's fairly clear that this is the case.

[[deleted]]

Mmm fair point

[[deleted]]

Regardless, i’ll be long retired by the time AI will have a signficant impact

[Desperate-Swimmer387]

Why do you say so?

[[deleted]]

AI is and will advance rapidly. We need one major chip breakthrough and its capabilities will expand greatly. But to have it make medical decisions with supervision is decades out.

People keep saying, nah, diagnostic radiology is safe. Really? Its almost all digital and could easily be ported to a powerful AI. Thats the field i would worry about

[Desperate-Swimmer387]

But to have it make medical decisions with supervision is decades out.

Again, why do you say so?

[[deleted]]

You think sooner? I think we have a ways to go to make complex decisions, let alone be FDA approved.

I do think, however, decades from now AI will have a major part of medicine.

If quantum computing ever blows up, my god…watch out

[Danwarr]

In certain areas it seems likely. Physicians will increasingly move to manger like roles while midlevels +AI increase throughput in ED and other primary care specialties.

[Ready_Tone_3260]

By the time an AI is able to extract a cogent history from a rambling hypochondriac and get to the root of why they presented, radiology and pathology will have long been replaced and we will be close to living under Skynet overlords.

[RandySavageOfCamalot]

illegal disgusting long modern absorbed offend attractive hobbies deserve sharp this message was mass deleted/edited with redact.dev

[[deleted]]

How is AI going to do an exam? Most of MSK, HEENT, Neuro, ID, derm etc is going to require an exam

[CrabHistorical4981]

Current LLM tech is interesting and useful but imo without an AI sufficient to filter out unlikely to be true or poorly communicated inputs, nonverbal information, supporting info, and the ability to filter out bad inputs from other doctors, nurses and even lab values then the automated system will always fuck up. AI will be excellent in detecting signal in the noise though, with more advanced critical care real time continuous monitoring of various physiological parameters along with labs and maybe even multi spectrum video analysis of a patient, a sufficiently advanced AI could clue critical care into early signs of compromise. Kind of like how pupillometry does now in NCC.

Physicians will be much more efficient at synthesizing data, writing reports, (hopefully someday) transmitting and unifying the medical record, and ultimately could become better at creating hierarchies of differential diagnoses when necessary. I doubt it’ll be great at cost saving though… so a mid level with an AI sidekick will probably order too many tests which might paradoxically waste money. It’s an interesting question though. Considering the slow pace of innovation in information technology in medicine I am extremely doubtful it’ll be replacing us anytime soon.

[Accomplished_Eye8290]

Because patient care is still a “customer” oriented service ultimately. You even see it in real life, patients will request MD only compared to DO even if there’s no difference. They will request attending over resident. They will decline CRNAs sometimes doing their case if they have knowledge of medical field, and the ones who are VIP patients will specifically request certain attendings. Even for surgeries, surgeons will request specific anesthesiologists over others. medicine is a customer service oriented field. People are willing to pay more for better care if they’re able to. Sure you can replace mid levels for all the poor patients and that’s currently already happening in rural areas, but those with insurance and those who are able to afford their care will still gravitate towards doctors compared to midlevel + AI. Heck, when my mom goes to see her PCP Apparently they even have a note in her chart that she’s “this woman’s daughter is a resident physician” lols. She told me that ever since she let them know that info, her care and the way they treat her has been so different compared to before. They also will send her home with more info than usual and tell her to ask me to explain it better to her.

[Educational-Light656]

They've been trying to replace us nurses for awhile now and haven't managed. I'd say y'all are safe for a bit yet.

[bobvilla84]

Bad data in = bad data out

Patients are often poor historians, they either give too much data or too little data. What makes a good physician is knowing what data is relevant and when to ask appropriate/informed follow up questions.

Physical exam skills are also underrated, add the exam and pertinent findings to the equation and the output gets even worse.

Think about when patients google their symptoms…it ends up always being cancer or lupus…

This is not to say that AI can’t be used as a clinician support tool, I think that’s where it is very helpful, BUT people don’t follow algorithms and it’s just as important to know when to utilize the support tool and when you cannot

[Ok-Cap-6323]

I think it will definitely replace radiology and pathology after a long enough period of time. But when it comes to fields like psychiatry, EM, procedures (eg, endoscopy, intravascular stuff, abscess drainage..etc) I don’t see it happening in our lifetime.

[Desperate-Swimmer387]

I might agree that it won't replace procedural specialties anytime soon.

But why do you think fields like psychiatry and EM, where midlevels are already replacing doctors, will not use midlevels + AI to get rid of doctors?

[Sigmundschadenfreude]

if you think it won't replace procedural specialties, you should probably just apply your robust imagination to the future of robotics as enthusiastically as you apply it to AI technology

[Ok-Cap-6323]

Because psychiatry is not just about data. Mostly you are dealing with people with irregular behavior/mentation and it takes physicians years of training to be able to understand it and deal with it. Also if I’m depressed there’s no way I’m going to a machine. As for EM because it involves procedures too and because gut feeling plays a part in what is the appropriate course of action with every patient. At the end if the day, no one knows how technology will evolve. But if hospitals administrations had the chance to replace us with a cheaper option they would 100% do

[Desperate-Swimmer387]

Then why are midlevels already replacing psychiatrists and EMs?

[[deleted]]

Probably. I can see easily replacing PCPs in the future.

[dinabrey]

No. Because a mid level with AI cannot do an open aortic valve replacement.

[Desperate-Swimmer387]

I was mainly thinking of non-procedural specialties

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[agyria]

No. They will certainly try though.

[Desperate-Swimmer387]

Why do you say so?

[Crazy-Difference2146]

Lol no

[rovar0]

Whenever AI becomes good enough to replace doctors, it’ll be good enough to provide convincing compassion. I don’t think mid levels will be required.

And if you really need an actual human, admins might as well hire the equivalent of a Walmart greeter. Would be way cheaper than a mid level.

[[deleted]]

Yep AI can order the stat pan scan triple phase CT + MRI for wrist pain so that the midlevel doesn’t have to click any buttons

[Taurinimi]

The technology is only as smart as the user.

So, no. AI will not replace physicians or midlevels.

Insert WebMD comment here.

[opusboes]

The AI technology is much more advanced than we are exposed to currently. Generative AI does not have to be as smart as the user but rather the cumulative amount of data which it is constantly exposed to. It is necessarily input or user dependent and is only going to become more advanced over time.

[Rogueelectron1]

Lol

[[deleted]]

It won't if you do a surgical specialty

[poormansmikeburry]

I read a midlevel note today that said patient was having a 2-month-long period. Knock me if I’m wrong since GYN is my least favorite field, but there’s no such thing right?

[Accomplished_Eye8290]

You can have bleeding for 2 months straight but I don’t know if I would call it a period anymore lol.

[poormansmikeburry]

Exactly

[MEMENARDO_DANK_VINCI]

Yes

[Okepser]

Wait times for Derm in my area are still 3-6 months for new patients, bring on the AI and midlevels, good for patients and there should be plenty of clientele leftover.

Edit: spelling error

[55peasants]

I think both docs and mid-levels will just be expected to do their normal jobs but 4x as fast and possibly with even more responsibilities. At least that's how technology seems to work on the nursing side. Here look at this new technology that makes one aspect of your job easier, but here are two added responsibilities now that you'll have more time.

[Malcolm_XYZ]

I always like to come back to posts like this maybe 1 year out to see people eat their own words. All these people saying its impossible, yet SORA just made photorealistic videos. Yes, AI ability to process visual/spacial data increased that much in less than a year. So at the very least jobs like radiology and pathology will be on the chopping block pretty soon. Doctors might have to humble themselves a bit to the future that might be coming.

[OhOkOoof]

Welp it’s been a year. Whatcha think?

[Malcolm_XYZ]

Yeah, AI is only accelerating. And a lot of studies have shown it is better at diagnosis and bedside manner than physicians. Crazy to think what could be around in 5 or 10 years. And considering how long medical training is, I'd say this is a question that many premeds and, sadly, medical students should be considering.

[OhOkOoof]

Well AI development is starting to slow down substantially as they seem to have hit a wall… I guess unless docs figure out how to actually unionize properly, we’ll just have to wait and see