Two Papers, Same Journal, Same Week
Last week one JAMA paper said AI's job is to dig the doctor out of paperwork so the doctor can be there for the patient again. This week another JAMA paper proposes letting AI see patients on its own — diagnose, recommend treatment, triage — without a doctor checking each case. Same journal. Same week. Opposite directions. So which one are we choosing?
I have been carrying two papers around for a few days now. Both came out in the same journal, on the same day, in the same week. They are pulling in opposite directions.
The first paper said AI's job is to dig the doctor out from under the pile of paperwork, so the doctor can be at the bedside again (Martinelli et al., 2026). That paper has been on my mind. The argument is one I find convincing — that AI is a tool that gives clinicians their work back.
The second paper, by Bergman, Wachter, and Emanuel, takes the opposite line. Same journal. Same week. The authors propose that AI should be licensed to see patients on its own (Bergman et al., 2026). To diagnose. To recommend treatment. To triage — that is, to decide who is sick enough to see a real doctor and who can be sent home.
All of that without a doctor reviewing each case.
What the proposal actually says
The authors are not careless. They are serious people making a serious case. Their words for what they are proposing are exact:
Autonomous clinical AI refers to systems that make care determinations, including diagnoses, treatment recommendations, and triage decisions, without clinician review of each case.
That is from the JAMA paper itself (Bergman et al., 2026). The word autonomous here means on its own. No human looking over the shoulder of every visit. The AI sees the patient. The AI decides.
Why this is different from what already exists
AI in medicine is not new. A lot of hospitals already use it. But almost everywhere, the AI is a helper — it suggests, and a doctor decides. A radiologist looks at the AI's read of a scan and signs off. A primary care doctor looks at the AI's draft of a visit note and edits it.
That is not what this paper is proposing. The paper is proposing that AI should be allowed to do the doctor's job. Not just help with it.
The case for this is not silly. There is a real shortage of doctors. There are entire counties in the United States with no primary care physician at all. Some rural areas have lost more than a thousand family doctors in just six years (Fogarty et al., 2025). For someone living there, no doctor is the current option. A licensed AI is, at minimum, more than that.
So the question is not silly either. It is just the question I think we are answering too fast.
Where I land, and where I want to go next
The space between those two papers is where I want to live for a minute. Same journal, two weeks apart. One paper saying AI is here to give the doctor back. The other saying we should let AI be the doctor.
My honest read is that the world is not ready for the second one yet. But I do not want to wave that away. The next chapter is about taking the strongest version of the case for before I lay out why I do not think we are there.
References
Bergman, A., Wachter, R. M., Emanuel, E. J. (2026). A Licensure Framework for Autonomous Clinical AI. JAMA. doi:10.1001/jama.2026.5483
Martinelli, C., Carnevale, V., Ercoli, A., et al. (2026). Artificial Intelligence Is Not the End of the Physician. JAMA. doi:10.1001/jama.2026.4356
Fogarty, C. T., Byun, H., Huffstetler, A. N. (2025). Family physician workforce trends: the toll on rural communities. Annals of Family Medicine, 23(6), 535–538. doi:10.1370/afm.240549
Coming up next
Chapter 2
The Case the Authors Make
Before disagreeing with someone smart, you have to be able to make their argument better than they made it. So I want to do that here. There is a real doctor shortage. AI has gotten genuinely good — one large 2025 study had it scoring better than physicians on safety. And the licensing proposal is more careful than the headlines make it sound. It is worth taking seriously before we say no.
Jun 9, 3:30 AM · in 22 hours
Chapter 3
Six Reasons We Are Not Ready
Saying wait has a cost. People in counties without a single primary care doctor are not a hypothetical. But going now has a cost too — and the costs land on the same people. Here are the six things I keep coming back to. Tests are not patients. The studies are about AI-helped doctors, not AI alone. AI fails confidently. People are not ready. The first deployments will land on those who already get less. And the rules to hold anyone responsible do not exist yet.
Jun 10, 3:30 AM · in 1 day
Chapter 4
What to Do Instead
Not yet is not the same as never. It is also not the same as do nothing. The doctor shortage is real and people are getting hurt by it now. So if autonomous AI is not the answer yet, what is? Use AI to free up the doctors we have. Train every clinician to use it well. Fix the workforce pipeline. Build the rules first — then the licenses. The order matters more than the destination.
Jun 11, 3:30 AM · in 2 days
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