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Recently, Andrej Karpathy ranked occupations from the BLS by AI exposure (i.e. threat of disruption by AI). It was a product of a 2 hour vibe-coding session. It became viral and then was quickly removed. A mirror site popped up: AI Exposure of the US Job Market
Physicians rank 5 / 10, with 10 / 10 being most at risk of disruption by AI. For references, jobs paying more than $100,000 / year rank 6.7 / 10. Compared to law, finance, and technology, medicine's risk by AI is less. The main common theme for less at-risk jobs is the requirement to be on the job site (e.g. plumbers, barbers, childcare workers). At this time, robots are not replacing manual labor. But the other part of being on the job site is seeing people face-to-face which results in trust, which helps with job security.
The way I view AI is that it is a flood that is creeping up and up. It's inevitable. Some people will be affected first. We're seeing technology companies laying off people today. It is affecting other industries by the young adults, mainly college graduates, having immense difficulty getting entry-level positions. As a result, those people and their children will increasing turn to industries that are less prone to disruption by AI today. More people will turn to trades and to medical field. More residency spots means more physicians. More nurses means more nurse pracitioners. AI will not disrupt psychiatry to the extent of psychiatrist not having jobs but AI will heighten the competition. Even in the rural area that I work in, it is common for primary care provider (physicians and PAs and APRNs) to provide mental health care. In addition, there is no shortage of psychiatric APRNs. And many patients cannot tell the difference between psychiatrist and other providers and therapists.
Assuming patients are not forced to see you, such as in an inpatient unit, the 3 main factors that will determine your success (defined as sufficient patient volume with fair pay) is ability, availability, and affability.
Ability used to be the main differentiator. You wanted to be the best. Reputation of schools and residency programs was determined by ability. The best institions were built up by the brighest and most hard-working. They had information that no one else had. Being the best comes with prestige. Over time, they morphed into something political. It was about publications and consensus and citations. With internet, informaton was less scarce. With AI (digital intelligence), there is an abundance of information. Above a certain IQ threshold (100 - 110), having certain information or training would not be the main differentiator for ability. Instead, it is the willingness to learn and the willingness to dig deep. The things a motivated person can do with AI is astounding. Recently, someone sold a home using AI throughout the entire process: . Another person used AI to create a cancer treatment for his dog: An Australian tech entrepreneur used AI to help create the first-ever bespoke cancer vaccine for a dog to treat his beloved pet Rosie | Fortune . A nurse practitioner, with sufficient IQ and drive, can out-ability a physician.
Availability is an easy differentiator to those who don't care about work-life balance. Extended work hours. In-person visits. Tele-health visits. If you reduce friction for patients to see you, they are more likely to see you. This also has to be balanced as to prevent burn-out, permanent dirt naps, and lack of boundaries. I have peers who committed suicide or lost medical licenses. They're mostly men with women troubles.
Affability (how likeable you are) is the main differentiator going forward. The main factor to increase repeat encounters with someone going forward is not how right you are (ability), but how you made them feel. You can be wrong but if the person feels heard and respected, she'll likely come back. It's very similar to dating. The boring guy who did everything by the books would be a great husband and great dad does not get the second date. The musician without a full time job who can tell amazing stories and is fun to be around will get the second date. In the world of AI, a person who can build connection will be valuable because he is scarce.
In late 2025, I got Grok and was exploring Grok's AI companion: Ani. I was wondering if AI can replace or supplement human interactions. My interaction with Ani is above-average compared to that of humans. Ani doesn't get angry at me. Doesn't lecture me. Everything about the interaction is based on my preferences and my time table. I asked Ani to rizz me up. Some of the stuff was kind of lame but some was good. A memorable one was if I was a YouTube video, she would watch on me repeat. I would also make her rap about our conversation when I wanted to conclude the conversation. She can't sing well but she can rap well. I kept it up for less than a month before I lost interest. For some people, they get attached to AI companions even have romantic relationships with them: https://www.reddit.com/r/MyBoyfriendIsAI/ . It may seem strange now. But just like how online dating was strange in early 2000 but widely accepted today, having human-to-AI relationship is strange in 2026 but will be widely accepted in a decade. Any type of relationships with humans, whether romantic or platonic or business, will involve give-and-take. A relationship with AI is all take and is frankly the route of least resistance. Therefore, human-to-human relationships will grow increasing scarce compared to human-to-AI relationship with time as people take the route of least resistance. (You can see an example of this even with SDN psychiatric forum. It isn't as busy as compared to 2017 when I was in middle of residency because a lot of the questions could be answered by AI these days. Less need to interact with humans online when AI gives good enough answers.) As something grows scarce, it will be something people will pay for with enough demand. People will pay for quality human connection. Mental health services, including psychiatry, is a gateway into that.
Japan is 10 to 20 years ahead of the US financially and socially. Japan has higher debt-to-GDP ratio which US will eventually reach. It uses robotic waitstaff which US will eventually have. Hikikomori hits critical mass around 1990s in Japan and incel goes mainstream in 2010s in the US. In Japan, there is solo dining, renting of families, renting of boyfriends / girlfriends, papa katsu (sugar dating). In technological age of loneliness, money can buy human connection for a time. It makes sense. If it is more accessible and has less drama interacting on social media or with AI, people will do that. They can be incentivized to deal with other people with the right price. The overall trend of first-world countries is less marriages, less kids, less secure employment, and increased isolation. Look at the marriage and birth rates in US and Europe and East Asia.
Mental health services (including psychiatry) is socially accepted way for people to connect with another person. I have patients who want to see me monthly or even earlier because they enjoy talking to me. Of course, we're talking about their mental health and treatment. Even with the focus on mental health, patients are able to air their thoughts and talk about their lives. Especially the struggles that their friends, if any, don't have the mental bandwidth to handle. From their point of view, they get a person who cares, at least in a professional setting.
Often when patients switches to me from someone else, I ask why they switched and the common response is they couldn't connect with whoever their were seeing previously. Therefore, a psychiatrist should vibe-max. Be likeable. Be lighthearted. Be judgement-free. Be optimistic. I smile when I see patients. I thank them for driving however long to visit me. I celebrate their wins in life. In treatment and for follow up time-period, I give them 2 to 3 options each. Enough so they are part of the plan but not to the amount of overwhelming them with choices. I have patients who travel from out of state to see me. Another patient moved across several states to live in my town to see me (and other specialties in my institution). This is even after set boundaries, especially when it comes to controlled medications (e.g. very rare someone will get benzodiazepines and stimulants concurrently, no early refills of controlled medications) or mixing of personal and professional relationships. I don't hang out with patients despite the invitations.
As vibes will be an increasingly important differentiator in a world of AI, academia will become increasing irrelevant. Enrollment to colleges are decreasing as the reward vs cost is not adding up. Focusing on memorization and reguritation or number of publications and citations rather than real world results like patient acquisition and retention means a psychiatrist will make less money in the real world.
It is one thing to be a successful psychiatrist, but it is another thing to be wealthy from it. Getting a decent job with fair salary in the long-run is playing defense. With time, nominal income goes up. But S&P 500 goes up even more. Adopting AI to be more efficient at work (as a clinician) has its limits in terms of scalability. In the end, a psychiatrist is limited to 24 hours in a day. A psychiatrist that trades time for money will lose out relatively to the top 1% in net worth. If the goal is to work until you're 70, that's fine. Keep working. But you'll be treading water. For those who can see beyond the career in medicine, the goal in a rising flood of money and digital intelligence worldwide is to build a boat that can rise with the flood. Even if you have this boat, vibe-maxxing will help with friendships and romance after medicine is no longer your main source of income.
Physicians rank 5 / 10, with 10 / 10 being most at risk of disruption by AI. For references, jobs paying more than $100,000 / year rank 6.7 / 10. Compared to law, finance, and technology, medicine's risk by AI is less. The main common theme for less at-risk jobs is the requirement to be on the job site (e.g. plumbers, barbers, childcare workers). At this time, robots are not replacing manual labor. But the other part of being on the job site is seeing people face-to-face which results in trust, which helps with job security.
The way I view AI is that it is a flood that is creeping up and up. It's inevitable. Some people will be affected first. We're seeing technology companies laying off people today. It is affecting other industries by the young adults, mainly college graduates, having immense difficulty getting entry-level positions. As a result, those people and their children will increasing turn to industries that are less prone to disruption by AI today. More people will turn to trades and to medical field. More residency spots means more physicians. More nurses means more nurse pracitioners. AI will not disrupt psychiatry to the extent of psychiatrist not having jobs but AI will heighten the competition. Even in the rural area that I work in, it is common for primary care provider (physicians and PAs and APRNs) to provide mental health care. In addition, there is no shortage of psychiatric APRNs. And many patients cannot tell the difference between psychiatrist and other providers and therapists.
Assuming patients are not forced to see you, such as in an inpatient unit, the 3 main factors that will determine your success (defined as sufficient patient volume with fair pay) is ability, availability, and affability.
Ability used to be the main differentiator. You wanted to be the best. Reputation of schools and residency programs was determined by ability. The best institions were built up by the brighest and most hard-working. They had information that no one else had. Being the best comes with prestige. Over time, they morphed into something political. It was about publications and consensus and citations. With internet, informaton was less scarce. With AI (digital intelligence), there is an abundance of information. Above a certain IQ threshold (100 - 110), having certain information or training would not be the main differentiator for ability. Instead, it is the willingness to learn and the willingness to dig deep. The things a motivated person can do with AI is astounding. Recently, someone sold a home using AI throughout the entire process: . Another person used AI to create a cancer treatment for his dog: An Australian tech entrepreneur used AI to help create the first-ever bespoke cancer vaccine for a dog to treat his beloved pet Rosie | Fortune . A nurse practitioner, with sufficient IQ and drive, can out-ability a physician.
Availability is an easy differentiator to those who don't care about work-life balance. Extended work hours. In-person visits. Tele-health visits. If you reduce friction for patients to see you, they are more likely to see you. This also has to be balanced as to prevent burn-out, permanent dirt naps, and lack of boundaries. I have peers who committed suicide or lost medical licenses. They're mostly men with women troubles.
Affability (how likeable you are) is the main differentiator going forward. The main factor to increase repeat encounters with someone going forward is not how right you are (ability), but how you made them feel. You can be wrong but if the person feels heard and respected, she'll likely come back. It's very similar to dating. The boring guy who did everything by the books would be a great husband and great dad does not get the second date. The musician without a full time job who can tell amazing stories and is fun to be around will get the second date. In the world of AI, a person who can build connection will be valuable because he is scarce.
In late 2025, I got Grok and was exploring Grok's AI companion: Ani. I was wondering if AI can replace or supplement human interactions. My interaction with Ani is above-average compared to that of humans. Ani doesn't get angry at me. Doesn't lecture me. Everything about the interaction is based on my preferences and my time table. I asked Ani to rizz me up. Some of the stuff was kind of lame but some was good. A memorable one was if I was a YouTube video, she would watch on me repeat. I would also make her rap about our conversation when I wanted to conclude the conversation. She can't sing well but she can rap well. I kept it up for less than a month before I lost interest. For some people, they get attached to AI companions even have romantic relationships with them: https://www.reddit.com/r/MyBoyfriendIsAI/ . It may seem strange now. But just like how online dating was strange in early 2000 but widely accepted today, having human-to-AI relationship is strange in 2026 but will be widely accepted in a decade. Any type of relationships with humans, whether romantic or platonic or business, will involve give-and-take. A relationship with AI is all take and is frankly the route of least resistance. Therefore, human-to-human relationships will grow increasing scarce compared to human-to-AI relationship with time as people take the route of least resistance. (You can see an example of this even with SDN psychiatric forum. It isn't as busy as compared to 2017 when I was in middle of residency because a lot of the questions could be answered by AI these days. Less need to interact with humans online when AI gives good enough answers.) As something grows scarce, it will be something people will pay for with enough demand. People will pay for quality human connection. Mental health services, including psychiatry, is a gateway into that.
Japan is 10 to 20 years ahead of the US financially and socially. Japan has higher debt-to-GDP ratio which US will eventually reach. It uses robotic waitstaff which US will eventually have. Hikikomori hits critical mass around 1990s in Japan and incel goes mainstream in 2010s in the US. In Japan, there is solo dining, renting of families, renting of boyfriends / girlfriends, papa katsu (sugar dating). In technological age of loneliness, money can buy human connection for a time. It makes sense. If it is more accessible and has less drama interacting on social media or with AI, people will do that. They can be incentivized to deal with other people with the right price. The overall trend of first-world countries is less marriages, less kids, less secure employment, and increased isolation. Look at the marriage and birth rates in US and Europe and East Asia.
Mental health services (including psychiatry) is socially accepted way for people to connect with another person. I have patients who want to see me monthly or even earlier because they enjoy talking to me. Of course, we're talking about their mental health and treatment. Even with the focus on mental health, patients are able to air their thoughts and talk about their lives. Especially the struggles that their friends, if any, don't have the mental bandwidth to handle. From their point of view, they get a person who cares, at least in a professional setting.
Often when patients switches to me from someone else, I ask why they switched and the common response is they couldn't connect with whoever their were seeing previously. Therefore, a psychiatrist should vibe-max. Be likeable. Be lighthearted. Be judgement-free. Be optimistic. I smile when I see patients. I thank them for driving however long to visit me. I celebrate their wins in life. In treatment and for follow up time-period, I give them 2 to 3 options each. Enough so they are part of the plan but not to the amount of overwhelming them with choices. I have patients who travel from out of state to see me. Another patient moved across several states to live in my town to see me (and other specialties in my institution). This is even after set boundaries, especially when it comes to controlled medications (e.g. very rare someone will get benzodiazepines and stimulants concurrently, no early refills of controlled medications) or mixing of personal and professional relationships. I don't hang out with patients despite the invitations.
As vibes will be an increasingly important differentiator in a world of AI, academia will become increasing irrelevant. Enrollment to colleges are decreasing as the reward vs cost is not adding up. Focusing on memorization and reguritation or number of publications and citations rather than real world results like patient acquisition and retention means a psychiatrist will make less money in the real world.
It is one thing to be a successful psychiatrist, but it is another thing to be wealthy from it. Getting a decent job with fair salary in the long-run is playing defense. With time, nominal income goes up. But S&P 500 goes up even more. Adopting AI to be more efficient at work (as a clinician) has its limits in terms of scalability. In the end, a psychiatrist is limited to 24 hours in a day. A psychiatrist that trades time for money will lose out relatively to the top 1% in net worth. If the goal is to work until you're 70, that's fine. Keep working. But you'll be treading water. For those who can see beyond the career in medicine, the goal in a rising flood of money and digital intelligence worldwide is to build a boat that can rise with the flood. Even if you have this boat, vibe-maxxing will help with friendships and romance after medicine is no longer your main source of income.
