Two Papers, Same Journal, Same Week

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