House bill 238 to give AI prescribing authority

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AJS59 said:
1. Who's able to get sued under this? The hospital? Open AI? Somehow I doubt that the Altman's of the world really want to wade their way into medical tort law.
2. Even if we entertain your idea that ChatGPT will replace physicians in prescriptive authority, do you genuinely believe or think that it will be able to do complex neurosurgery or transplant surgery cases when ChatGPT exists entirely within the internet????
3. So you think all med schools will close up shop and that this year is that last cycle anyone will ever be able to earn an MD????

Be for real man. Are you even a med student or just a troll?
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Perhaps both?
 
voxveritatisetlucis said:
This would kill the job market for PCPs. At least half of all visits to your local FM/peds Doctor are for things like pneumonia,UTI,adhd,anxiety etc. without these visits, I doubt primary care clinics would be able to stay afloat
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You really need to just stop posting.

I'm booked out for weeks, when would I see any acute stuff much less half of visits being for that?

This is very common in the primary care world. This is exactly why urgent cares became a thing.
 
Lost in Translation said:
Has OP even done their OBGYN rotation yet? They might pass out at the sight of their first pelvic exam.
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dont u know pelvic exams done by humans is going to become obsolete with AI?

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just look at these bad boys - OBGYNs are cooked
 
Link to another poster who has the direct link to the bill
clausewitz2

Post in: 'H.R.238 - To amend the Federal Food, Drug, and Cosmetic Act to clarify that artificial intelligence can qualify as a practitioner'

calvnandhobbs68 said:
Also this is quite a bit getting the cart ahead of the horse...I would think a major question would be how are you going to give an AI program the ability to do something that currently requires a license to do independently (ex. practice medicine) without first having to work around who or what could be licensed to practice medicine.



Idk man Gemini 1.5 pro still calls F90.2 "hyperkinetic disorder" I'm never terribly impressed when I play with these things.
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These things are extremely sensitive to initial prompts, I'd be curious as to the specifics of what you are asking...
 
VA Hopeful Dr said:
You really need to just stop posting.

I'm booked out for weeks, when would I see any acute stuff much less half of visits being for that?

This is very common in the primary care world. This is exactly why urgent cares became a thing.
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Seriously. I moved in September and trying to establish with new docs, even with my connections, is so difficult! I managed to book a gyn appt for March and I lucked into a cancellation spot at the end January with nephrology, otherwise the one other date available in February is when I’m out of town for vacation, and the next availability is also March. I haven’t established with a PCP yet because most of them are booked out 3-6 months. They keep offering NP visits but I want to see a physician.
 
operaman said:
Already it’s scribing for us, managing inbox messages for some. It writes all my insurance appeals now - just copy paste from gpt. I use it for decision support and evidence review especially for things that are rare. It will soon get good at coding and billing too and for a time docs will make more money.
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Scribing and filling out letters/appeals I can see. I don't see AI being able to manage inbox messages anytime soon beyond fairly basic boilerplate guidelines unless there are very specific algorithms in treatments guidelines that can answer the question. I do see the automation of messages potentially happening just like it's been outsourced/automated with any customer service industry, but I think it'll just serve to piss patients off more that they don't get to talk to a "real person" (it definitely would with my psych patients). I could also see it eventually being used for billing as well, but I don't think it's really there yet, even so that would be a threat to billing department staff, not physicians.

Regardless, the author of this bill seems like a bit of a nut. Other bills he's currently proposing include releasing the full records on JFK's assassination to the public and making sure every product with xylitol in it has a label that says it's toxic for dogs...
 
Stagg737 said:
Scribing and filling out letters/appeals I can see. I don't see AI being able to manage inbox messages anytime soon beyond fairly basic boilerplate guidelines unless there are very specific algorithms in treatments guidelines that can answer the question. I do see the automation of messages potentially happening just like it's been outsourced/automated with any customer service industry, but I think it'll just serve to piss patients off more that they don't get to talk to a "real person" (it definitely would with my psych patients). I could also see it eventually being used for billing as well, but I don't think it's really there yet, even so that would be a threat to billing department staff, not physicians.

Regardless, the author of this bill seems like a bit of a nut. Other bills he's currently proposing include releasing the full records on JFK's assassination to the public and making sure every product with xylitol in it has a label that says it's toxic for dogs...
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Well good news for him DJT is releasing the JFK records anyway. 😂 🙄🤪
 
Have any of you actually used deepseek or O3 on a patient? Putting pride aside, I guarantee it can come up with a better plan/differential. I guess the question is, if it can replace a doctor then what can’t it replace. Even if doctors weren’t replaced, everybody would be on Medicaid and the govt would basically be forced to pay doctors next to nothing since there would be a much lower tax base

Maybe they should just ban AI entirely. Of course it won’t happen but it should
 
Stagg737 said:
Scribing and filling out letters/appeals I can see. I don't see AI being able to manage inbox messages anytime soon beyond fairly basic boilerplate guidelines unless there are very specific algorithms in treatments guidelines that can answer the question. I do see the automation of messages potentially happening just like it's been outsourced/automated with any customer service industry, but I think it'll just serve to piss patients off more that they don't get to talk to a "real person" (it definitely would with my psych patients). I could also see it eventually being used for billing as well, but I don't think it's really there yet, even so that would be a threat to billing department staff, not physicians.

Regardless, the author of this bill seems like a bit of a nut. Other bills he's currently proposing include releasing the full records on JFK's assassination to the public and making sure every product with xylitol in it has a label that says it's toxic for dogs...
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Yeah I doubt it can do good messages, though some studies have suggested they do a decent job.

For someone like me it would be perfect because I’ve never once even opened my message inbox. I have my staff do it and they’re savvy enough to answer the easy ones, schedule the complicated ones for an actual appointment, and they ask me about the questionable ones. I do think an AI could probably be taught to do that much.

Personally I refuse to do anything requiring medical decision making via inbox messaging. Anything with decision making gets a real visit.
 
voxveritatisetlucis said:
Have any of you actually used deepseek or O3 on a patient? Putting pride aside, I guarantee it can come up with a better plan/differential. I guess the question is, if it can replace a doctor then what can’t it replace. Even if doctors weren’t replaced, everybody would be on Medicaid and the govt would basically be forced to pay doctors next to nothing since there would be a much lower tax base

Maybe they should just ban AI entirely. Of course it won’t happen but it should
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Buddy, if you truly believe that making a differential diagnosis is the entire essence of what it means to be a physician and care for patients, then you are even more naive and limited in your understanding of the career path that you are on than I thought. Which is really saying something because my opinion was already hella low. 🤦🏼‍♀️

Making a differential is something that experienced physicians do reflexively and damn near unconsciously in most cases. It is the basic beginning of doctoring. It is the medical education equivalent to Sesame Street: A, B, C; 1, 2, 3; triangle, circle, square. You are getting a lot of emphasis on it in your current level of training because you are a student and, while it is a very important skill, it is as basic as it gets. The goal is to get to the point where your brain operates on a near unconscious level with some of this stuff. So you can then take on the task of learning when to apply the standard and not so standard treatments and recommendations in an individualized context that takes into account the current evidence-based data, a patient’s age, frailty, co-morbidities, current and past clinical status, and the patient’s socioreligious beliefs and emotional and family structure and about 100 other factors. Sure I bet AI makes a reasonable differential. Because it’s pretty basic ****. It’s the stuff you gotta spend a lot of time getting good at so you can move onto the stuff that’s hard.

Look as a surgeon I gotta recommend you stay the heck away from my field. You don’t have the slightest concept of what being at the bedside of a patient in their hour of need, or caring for them chronically, or being a member of a healthcare team, means.

*Considered using, but did not use, ChatGPT to write this post. 🤣😜
 
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voxveritatisetlucis said:
Have any of you actually used deepseek or O3 on a patient? Putting pride aside, I guarantee it can come up with a better plan/differential.
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While I can imagine that these may be able to come up with a better plan/differential than you as an MS3, no, I would not guarantee that it would do better than an attending. The fact that you're so sure is offensive.
voxveritatisetlucis said:
I guess the question is, if it can replace a doctor then what can’t it replace. Even if doctors weren’t replaced, everybody would be on Medicaid and the govt would basically be forced to pay doctors next to nothing since there would be a much lower tax base
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This has nothing to do with AI and is just another reason you're worried you're not going to be rich as a physician. Which, fine, I guess we aren't as well off as prior generations. But I think we're still doing pretty well.
 
I have so many examples of why AI will never replace what I do but don't want to bore everyone with the details.
Physical exams and knowledge of anatomy is still vital to being a good doctor. I have been placing central lines and performing thoracentesis since before bedside ultrasounds were a thing.
@voxveritatisetlucis, finish med school and residency, work as a doctor for a few years, then you will realize we can't be replaced by AI (or NPs and PAs). Instead, AI will just be another tool to help us be better doctors.
By the way, you don't have to be the top student to match into general surgery. There are many community general surgery programs that provide excellent training and turn out excellent surgeons. Community general surgery residents will graduate with hundreds, if not more, cases under their belts and have much, much more operative experience than their university trained colleagues.
 
operaman said:
Yeah I doubt it can do good messages, though some studies have suggested they do a decent job.

For someone like me it would be perfect because I’ve never once even opened my message inbox. I have my staff do it and they’re savvy enough to answer the easy ones, schedule the complicated ones for an actual appointment, and they ask me about the questionable ones. I do think an AI could probably be taught to do that much.

Personally I refuse to do anything requiring medical decision making via inbox messaging. Anything with decision making gets a real visit.
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NIH is giving R01s for these kinds of questions, the one I saw was a clinical trial for answering questions using NLPs. Your chatbot might be closer than you think.
 
HuskyMD Emeritus said:
I have so many examples of why AI will never replace what I do but don't want to bore everyone with the details.
Physical exams and knowledge of anatomy is still vital to being a good doctor. I have been placing central lines and performing thoracentesis since before bedside ultrasounds were a thing.
@voxveritatisetlucis, finish med school and residency, work as a doctor for a few years, then you will realize we can't be replaced by AI (or NPs and PAs). Instead, AI will just be another tool to help us be better doctors.
By the way, you don't have to be the top student to match into general surgery. There are many community general surgery programs that provide excellent training and turn out excellent surgeons. Community general surgery residents will graduate with hundreds, if not more, cases under their belts and have much, much more operative experience than their university trained colleagues.
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Your thinking about general surgery in regards to the match (you probably know more about the specialty than me based on your username) is outdated. Of course it’s not going to be as competitive as neurosurgery or plastics but as more and more med students realize that specialties like rads, path, FM will be taken over by AI the more will apply to all surgery specialties. I am willing to make a 5000 dollar bet with anybody on this forum that the general surgery match rate next year will be below 75 (compared to about 85 at which it has been historically)
 
voxveritatisetlucis said:
Your thinking about general surgery in regards to the match (you probably know more about the specialty than me based on your username) is outdated. Of course it’s not going to be as competitive as neurosurgery or plastics but as more and more med students realize that specialties like rads, path, FM will be taken over by AI the more will apply to all surgery specialties. I am willing to make a 5000 dollar bet with anybody on this forum that the general surgery match rate next year will be below 75 (compared to about 85 at which it has been historically)
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Not outdated. My daughter is a general surgery resident. I am on faculty at a medical school and I also round with residents.
 
voxveritatisetlucis said:
Your thinking about general surgery in regards to the match (you probably know more about the specialty than me based on your username) is outdated. Of course it’s not going to be as competitive as neurosurgery or plastics but as more and more med students realize that specialties like rads, path, FM will be taken over by AI the more will apply to all surgery specialties. I am willing to make a 5000 dollar bet with anybody on this forum that the general surgery match rate next year will be below 75 (compared to about 85 at which it has been historically)
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Don’t use loan money to make stupid bets rookie.
 
voxveritatisetlucis said:
Your thinking about general surgery in regards to the match (you probably know more about the specialty than me based on your username) is outdated. Of course it’s not going to be as competitive as neurosurgery or plastics but as more and more med students realize that specialties like rads, path, FM will be taken over by AI the more will apply to all surgery specialties. I am willing to make a 5000 dollar bet with anybody on this forum that the general surgery match rate next year will be below 75 (compared to about 85 at which it has been historically)
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I'm not in the habit of betting 5000 dollars (I am conscious of my own loan money, after all) but you have no evidence proving this beyond hearsay. Seriously if you are so worried about AI taking over everything then I recommend forgoing the match altogether and building an underground bunker somewhere in Wyoming to wait it out, I guess.
 
voxveritatisetlucis said:
I am willing to make a 5000 dollar bet with anybody on this forum that the general surgery match rate next year will be below 75 (compared to about 85 at which it has been historically)
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Here is the most recent Table 1A data from the NRMP for categorical surgery positions.

2024: 1480 applicants, 1070 matches (72.3%)
2023: 1466 applicants, 1062 matches (72.4%)
2022: 1467 applicants, 1059 matches (72.2%)
2021: 1405 applicants, 1029 matches (73.2%)
2020: 1378 applicants, 1033 matches (75.0%)

During this time the number of positions increased from 1536 to 1717.
 
Med Ed said:
Here is the most recent Table 1A data from the NRMP for categorical surgery positions.

2024: 1480 applicants, 1070 matches (72.3%)
2023: 1466 applicants, 1062 matches (72.4%)
2022: 1467 applicants, 1059 matches (72.2%)
2021: 1405 applicants, 1029 matches (73.2%)
2020: 1378 applicants, 1033 matches (75.0%)

During this time the number of positions increased from 1536 to 1717.
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Is this USMD? so 1070 matches but 1717 spots so ~700 unfilled positions? trying to learn more more ab process...could you explain?
 
RockClimberMed said:
Is this USMD? so 1070 matches but 1717 spots so ~700 unfilled positions?
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It is US MD seniors. In 2024 a total of 1712 of the 1717 of the spots were filled, 1070 by US MD seniors and the rest by other groups (DO, IMG, US MD grads, etc.).

RockClimberMed said:
trying to learn more more ab process...could you explain?
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This data (and much more) is available through the NRMP website: Match Data
 
I don’t think that is for first choice categorical surgery though many apply as backup
 
voxveritatisetlucis said:
auscultation and palpation, I’ll give you, but it can view images. I’d say it’s on par with most dermatologists when it comes to skin pathology. In regards to murmurs, I feel like most IM attendings can’t even reliably differentiate murmurs. Cardiologists maybe, but what is the difference if most end up getting an echo anyways
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You're making some pretty bold claims here. What's your source for AI being "on par with most dermatologists when it comes to skin pathology" ? I'm not saying you're wrong, but I'm going to need a source more reliable than "dude on Internet forum." 🙂
 
LucidSplash said:
But what does that have to do with the price of tea in China?
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Year / Charting Outcomes / Table 1A / delta
2024 / 81.8 / 72.3 / 9.5
2022 / 81.6 / 72.2 / 9.4
2020 / 83.2 / 75.0 / 8.2
2018 / 84.0 / 74.4 / 9.6

They seem reasonably correlated. If the assertion is correct and we see the general surgery match rate plummet I bet it will show up in the 2025 Table 1A. The next Charting won't be out until 2026.
 
So I will say that @voxveritatisetlucis 's point that gen surg and all procedural specialties are likely to become more competitive is probably true. This follows the pattern that you guys point out has already existed over the past several years, but it wouldn't be entirely unreasonable to posit that the increase in competitiveness could accelerate in this specific 2 year stretch given the heightening concern about AI encroachment.

Where this goes off the rails is the baseless doomsaying that PCPs are going to be poor and unable to get a job.
 
GoSpursGo said:
So I will say that @voxveritatisetlucis 's point that gen surg and all procedural specialties are likely to become more competitive is probably true. This follows the pattern that you guys point out has already existed over the past several years, but it wouldn't be entirely unreasonable to posit that the increase in competitiveness could accelerate in this specific 2 year stretch given the heightening concern about AI encroachment.

Where this goes off the rails is the baseless doomsaying that PCPs are going to be poor and unable to get a job.
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That's been the refrain for at least the last 30 years. Managed care, midlevels, AI, the list just keeps getting bigger.
 
I just did an ED shift with an attending who had DAX ai on his phone as the hospital is working on incorporating it throughout the entire system. You just let patients know that your phone is recording for note taking purposes and you transfer the data to EPIC. It did a fantastic job and allowed me as a medical student to see in real time how my discussion of physical exam and differentials get turned into a note.

The doctor seemed very happy as he got to spend more time with patients and less time talking into dragon for every single note. He had zero concerns that he was going to be replaced anytime soon.

Just food for thought.
 
Rapsidy said:
I just did an ED shift with an attending who had DAX ai on his phone as the hospital is working on incorporating it throughout the entire system. You just let patients know that your phone is recording for note taking purposes and you transfer the data to EPIC. It did a fantastic job and allowed me as a medical student to see in real time how my discussion of physical exam and differentials get turned into a note.

The doctor seemed very happy as he got to spend more time with patients and less time talking into dragon for every single note. He had zero concerns that he was going to be replaced anytime soon.

Just food for thought.
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So it's scribes who are in trouble!!!
 
Rapsidy said:
I just did an ED shift with an attending who had DAX ai on his phone as the hospital is working on incorporating it throughout the entire system. You just let patients know that your phone is recording for note taking purposes and you transfer the data to EPIC. It did a fantastic job and allowed me as a medical student to see in real time how my discussion of physical exam and differentials get turned into a note.

The doctor seemed very happy as he got to spend more time with patients and less time talking into dragon for every single note. He had zero concerns that he was going to be replaced anytime soon.

Just food for thought.
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That is just hubris because there’s no way that doctors won’t be replaced if an AI can take patient answerw and turn it into a reliable plan
 
voxveritatisetlucis said:
That is just hubris because there’s no way that doctors won’t be replaced if an AI can take patient answerw and turn it into a reliable plan
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Who's performing the physical exam again? How is the AI going to be able to read in between the lines of a social history for evaluating pulmonary diseases? Once again, nonsense
 
voxveritatisetlucis said:
That is just hubris because there’s no way that doctors won’t be replaced if an AI can take patient answerw and turn it into a reliable plan
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Shockingly, you completely missed the point of the post. You still treat it like a dragon in a sense, say out loud the physical exam findings, and TALKING with your coworkers to rule in and rule out tests and diagnosis. It just organizes it easily and allows more time doing medicine and less time scribing.
 
Rapsidy said:
I just did an ED shift with an attending who had DAX ai on his phone as the hospital is working on incorporating it throughout the entire system. You just let patients know that your phone is recording for note taking purposes and you transfer the data to EPIC. It did a fantastic job and allowed me as a medical student to see in real time how my discussion of physical exam and differentials get turned into a note.

The doctor seemed very happy as he got to spend more time with patients and less time talking into dragon for every single note. He had zero concerns that he was going to be replaced anytime soon.

Just food for thought.
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I just watched my boss use this today for his vein clinic. Watching it in action convinced me to try it. It was pretty impressive.
 
voxveritatisetlucis said:
That is just hubris because there’s no way that doctors won’t be replaced if an AI can take patient answerw and turn it into a reliable plan
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That’s not how it works. You state the plan to the patient and the AI records that in a formatted version in the note. The AI doesn’t come up with the plan.

You think AI is going to take over and talk a big game like you have this in depth understanding of where AI stands now so you think you can predict the future, when you don’t even understand one of the bigger players in the space and how it functions.

You need to sit down. The grownups are talking. You sound like a high school student who took their first biology class trying to explain anatomy to the seasoned surgeon. You are on the wrong part of the Dunning-Kruger curve in all respects. Talk about hubris.
 
LucidSplash said:
That’s not how it works. You state the plan to the patient and the AI records that in a formatted version in the note. The AI doesn’t come up with the plan.

You think AI is going to take over and talk a big game like you have this in depth understanding of where AI stands now so you think you can predict the future, when you don’t even understand one of the bigger players in the space and how it functions.

You need to sit down. The grownups are talking. You sound like a high school student who took their first biology class trying to explain anatomy to the seasoned surgeon. You are on the wrong part of the Dunning-Kruger curve in all respects. Talk about hubris.
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There are some being piloted at JHU MGH where the plan is generated entirely from the encounter. No explaining needed
 
voxveritatisetlucis said:
There are some being piloted at JHU MGH where the plan is generated entirely from the encounter. No explaining needed
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So who or what explains the diagnosis to the patient in a way they can understand and engages them in shared decision-making to generate a plan. You do realize that no matter what you have to discuss things with the patient and not just generate a note? The explaining is part of the doctoring.
 
voxveritatisetlucis said:
That is just hubris because there’s no way that doctors won’t be replaced if an AI can take patient answerw and turn it into a reliable plan
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OK. If you are this worried about AI, it is not too late for you to change your career path and find something you think is at lower risk for technology encroachment. I have a lot of things that worry me about medicine far more than AI.
 
voxveritatisetlucis said:
That is just hubris because there’s no way that doctors won’t be replaced if an AI can take patient answerw and turn it into a reliable plan
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I took the red pill and now I believe.

Make sure all your attendings and mentors know the truth. Lean hard on it at your residency interviews, bring it up unprompted if necessary. The world needs to know. /s
 
voxveritatisetlucis said:
I hope that I match surgery, which despite getting all honors except for 1 and having decent research, still may not be likely due to the surge in competitiveness (as more people look towards procedural fields, in my class alone there are 50 planning to apply surgical field or anesthesia compared to only 20 who applied this year)

If I don’t match, then I’ll probably just do EM or something and likely be replaced. But by that time, most jobs won’t exist anyway. The smarter thing to do would just be to ban AI since it’s going to lead to economic chaos not seen since the Great Depression
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You probably won’t match general surgery if you’re even half this annoying IRL
 
Med Ed said:
Still waiting for answers to my questions.
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Okay it’s NYU so maybe a bit off. From the article

“The new study found that AI feedback also increased the accuracy in contingency planning and note-based clinical assessments and reasoning.”
 
voxveritatisetlucis said:
Okay it’s NYU so maybe a bit off. From the article

“The new study found that AI feedback also increased the accuracy in contingency planning and note-based clinical assessments and reasoning.”
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You mean this article, where "Artificial intelligence (AI) feedback improved the quality of physician notes written during patient visits, with better documentation improving the ability of care teams to make diagnoses and plan for patients’ future needs..."?

If so, you have misrepresented things. AI is being used here to augment existing practice, not replace it.

“Our study provides evidence that AI can improve the quality of medical notes, a critical part of caring for patients,” said lead study author Jonah Feldman, MD, medical director of clinical transformation and informatics within NYU Langone’s Medical Center Information Technology (MCIT) Department of Health Informatics. “This is the first large-scale study to show how a healthcare organization can use a combination of AI models to give note feedback that significantly improves care quality.”
 
Med Ed said:
You mean this article, where "Artificial intelligence (AI) feedback improved the quality of physician notes written during patient visits, with better documentation improving the ability of care teams to make diagnoses and plan for patients’ future needs..."?

If so, you have misrepresented things. AI is being used here to augment existing practice, not replace it.

“Our study provides evidence that AI can improve the quality of medical notes, a critical part of caring for patients,” said lead study author Jonah Feldman, MD, medical director of clinical transformation and informatics within NYU Langone’s Medical Center Information Technology (MCIT) Department of Health Informatics. “This is the first large-scale study to show how a healthcare organization can use a combination of AI models to give note feedback that significantly improves care quality.”
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But where will it be in 5 or 10 years? MDs who work on these projects make me sick because they’re selling out the future generation of medical students just like those who sold their practices to private equity throughout the 2000s and 2010s. Sell outs
 
voxveritatisetlucis said:
But where will it be in 5 or 10 years?
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Have you considered becoming a hobo? Plenty of fresh air, lots of free time, few responsibilities, and very little to lose. It could be a good move for you.

You still haven't answered on the physical exam issue (other than deflection), haven't informed us which data you will use to monitor changes to the general surgery match rate this cycle, and are now just fabricating research studies to try and further your point. I don't recall SDN having so many paranoid doom-loops back in the day. Perhaps this is a generational thing?
 
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