The US is nearing a critical juncture in the delivery of clinical care. Physician supply is tightening while demographic trends increase demand. Simultaneously, artificial intelligence (AI) systems, particularly large language models, are beginning to demonstrate competencies that overlap meaningfully with the cognitive tasks integral to clinical care. [JAMA Network] 

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The clinician shortage and rapid advances in AI are usually treated as separate policy issues. Both must be considered together. The workforce shortfall creates urgent demand for autonomous clinical AI—agents that make care determinations independently, without per-case clinician review—whereas the adaptive nature of that technology and the risks associated with many clinical decisions demand a fundamentally different regulatory framework. Existing regulatory frameworks for clinical AI are ill suited to adaptive, general-purpose systems. Instead, a licensure-based approach, grounded in ongoing clinical evaluation, offers a safer path forward.

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