Don’t be fooled by the question mark in the title of an article published this month in the Journal of the American Medical Association. When the authors, including medical superstar Ezekiel Emanuel and venture capitalist Vinod Khosla, asked, “Will Autonomous AI Exceed AI-Physicians as the Best Medical Care?” they were being rhetorical. Their answer is an emphatic YES. Many in the medical world are begrudgingly coming to terms with the premise that patients can get the best treatment by a hybrid approach where doctors work in consultation with well-trained bots. But this article’s thesis is that AI alone can deliver the best outcomes.
“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 five fundamental medical tasks,” they write. Those tasks include taking medical histories, establishing a diagnosis, identifying what tests are needed, prescribing treatment, and managing chronic diseases. You know, doctoring. AI is now so good, they argue, that clinicians should refrain from meddling, because “humans in the loop degrade AI performance.” Stand back, doc, and let AI do its thing. Which used to be your thing.
Lead author Emanuel—brother of Ari and Rahm, chair of the Department of Medical Ethics and Health Policy at Penn and a renowned oncologist—told me that for many years, he’d dismissed the idea that AI could perform core medical functions. He would run into Khosla at conferences in the 2010s, and the VC would bend his ear about how AI would be doing 85 percent of what doctors did by 2035. It was a hobbyhorse Khosla had been riding for years, writing a 2012 piece in TechCrunch asking, “Do We Need Doctors or Algorithms?”(again, rhetorical) and penning a 101-page treatise in 2016 to that effect. “I said bullshit, there’s no way,” says Emanuel. “What doctors do is too complicated.”
But about a year ago, Emanuel’s friend Robert Wachter sent him galleys of his book A Giant Leap, where Wachter, who is head of medicine at UCSF, outlined a world where first-class medicine would be a collaborative process between AI and doctors, but the masses in “economy class” would mostly make do with AI alone. Emanuel began to think that Khosla might be right. He suddenly flashed on a frightening question: “If AI takes over, what’s left for doctors to do?”
First he needed to validate the premise. He asked Khosla to collaborate, and the VC suggested that his son Neal Khosla join the effort, along with Emanuel’s researcher. Neal runs Curai Health, an online company that uses AI to treat patients, with a staff of doctors to prescribe medicine and handle more complicated issues. (This conflict of interest is disclosed in the paper, along with Vinod Khosla’s relevant investments and Emanuel’s various grants and consultancies.) The coauthors set out to look at all the studies on AI medicine that they could find from January 2024 to the present and concluded that, in many cases, a “superior autonomous AI” will likely surpass humans using AI by 2030. That prediction, they admit, is “unsettling but seems probable.”
Unsettling is an understatement. One of the loudest dissenting voices is John Whyte, CEO of the American Medical Association, which represents all those doctors who will be worrying about what’s left. When I talked to him, Whyte began by noting what he saw as the paper’s shortcomings, including that some of the studies it surveyed are simulations, not blind experiments, and they don’t all support the article’s conclusion. Notably, a February 2026 Nature article found that in real-life cases, most patients were unable to effectively converse with large language models to access their expertise. Whyte unsurprisingly bristled at the idea of removing humans from the clinical loop. “The AMA does see the potential in these tools, but they have to be utilized in the context of a care plan that’s governed by a physician,” he says.
Emanuel countered that he and his coauthors were careful in their conclusions. “It’s been less than four years since ChatGPT was introduced,” he said to me. “We’re making a prediction for four years from now. You don’t think that [AI is] going to be way more advanced than a doctor?”
Seeking a second opinion, I consulted Wachter. He’s singled out in the paper’s first paragraph as the guy who wrongly argues that AI-only treatment will be “economy class.” (I know Wachter personally.) Surprisingly, Wachter concedes that the authors of the paper have a point. “The argument they’re making is important,” he says. AI is good, he says, and right now AI and humans together are better. “But that can no longer be chiseled into a tablet. There will be times when humans will muck up the performance.”
Wachter is insistent, however, that the unique human attributes of trained physicians are vital and irreplaceable. AI may never be as effective in breaking the news of a grim prognosis than a human, and a patient may well be more likely to be guided to the best path of treatment by a real-life clinician.
Wachter invokes what he calls the doorman fallacy, named after the fear that people who opened doors for tenants in apartment buildings would be out of work once doors could open automatically. In fact doormen perform myriad tasks and are still an invaluable presence in white-glove buildings. Like accepting Amazon packages, feeding pets, and sometimes lending a sympathetic ear to a tenant sharing a gripe. “We’re going to find a version of the doorman fallacy for doctors,” says Wachter. “I can imagine a world where a doctor accepts the AI diagnosis but also performs a lot of other functions that have value.”
What’s being displaced here, though, isn’t something as straightforward as opening a door. It’s the hard-won expertise that comes from years of training. You know those scenes in The Pitt where Dr. Robby relentlessly puts his residents on the spot by asking them to come up with instant assessments? That won’t be necessary when AI has the answer on demand. Physicians are on a path to relying so much on AI that their own judgment and knowledge will become less relevant. This “de-skilling” process could accelerate the takeover of medicine by AI, especially as new generations of doctors won’t find it necessary to spend years learning stuff that they can find out by querying an always-on AI expert in the pocket of their lab coat. The AMA’s Whyte admits that this is a concern for him. “A lot of medical schools and residency programs are debating whether physicians in their training can utilize these tools, because if you’ve never learned how to take medical history and do a physical, how will you ever learn?” On the other hand, there’s an argument that ignoring such a compelling tool is a form of malpractice.
So what’s the future for doctors? Vinod Khosla says that we’ll need them, at least in the short term, for surgery and in the emergency room. But in terms of providing expertise and judgment, he says they’re largely expendable, except maybe as debaters with AI to improve those systems. Neal Khosla tells me that the shift is already underway and that he expects that in coming years we will give AI the regulatory permission to prescribe medicine.
Remember the TV series House, where a dyspeptic and rude diagnostic genius decoded baffling conditions while insulting patients and humiliating his hapless acolytes? In the world of AI medicine, a Dr. House would be rendered homeless, because AI will routinely and freely apply its vast knowledge base to the most obscure ailments. The value of human clinicians will be the elements where House was most lacking, like empathy and high-EQ communication. Of course those who perform hands-on procedures are safe from AI encroachment—until the robots figure that out.
Health care is a huge part of our lives, but the debate here goes beyond that sector. The question, “What’s left for doctors to do?” may well be “What’s left for humans to do?” Bill Gates suggests in his recent jeremiad on AI that society might designate some tasks—like doctors counseling patients on how to deal with AI’s prognoses—“human-reserved,” to stave off economic ruin and a run on pitchforks. (Try to sell that solution to corporate shareholders who question the funding of make-work jobs.) At least the misery of the unemployed masses will be mitigated by one bonus: first-class medical advice that’s one click away.
This is an edition of Steven Levy’s Backchannel newsletter. Read previous newsletters here.
