The prevailing view of artificial intelligence (AI) in medicine is that it will support physician-led care. The American Medical Association regularly calls AI augmented intelligence to focus on AI’s assistive role. Similarly, the American College of Physicians argues that AI “should be limited to a supportive role in clinical decision-making” and “should not replace physician decision-making.” In A Giant Leap: How AI Is Transforming Healthcare and What That Means for Our Future, Wachter1 argues that the highest tier of care will be AI-aided physicians, whereas AI-only care will be medicine’s “economy class.”
We disagree. In cognitive medical functions, AI-alone medical care is likely to be better than physician-only or physician-AI hybrid care. Large language models (LLMs) were only publicly introduced in November 2022, and already generative AI rivals or outperforms licensed physicians at 5 fundamental cognitive medical tasks: (1) eliciting medically relevant information; (2) establishing a differential diagnosis; (3) specifying diagnostic testing; (4) prescribing guideline-concordant treatment; and (5) managing chronic diseases. The gap between physicians’ and LLMs’ performance will likely widen because AI is rapidly improving, whereas physicians’ skills are threatened by AI-induced deskilling.2,3
Data from medicine and other fields suggest that when AI-alone performance is consistently superior to human-alone performance, AI alone surpasses human-AI hybrids. Paradoxically, hybrid care in which humans are in (or on) the loop to correct AI errors is likely to worsen rather than improve AI performance. Review of all published articles on AI in medicine since January 1, 2024, shows that medicine is rapidly approaching the transition point at which AI alone will exceed physicians and physician-AI hybrids in providing the best care at 5 fundamental cognitive medical tasks.
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