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Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023
| Contributor Information
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Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
With each passing day, a future with artificial intelligence (AI) playing a significant role in medicine seems more assured. Some physicians may be enthusiastic about a future in which AI takes over many administrative tasks, but others have misgivings. Medscape surveyed US physicians about their expectations for AI in their workplace — and how they anticipate their employers harnessing the technology.
In this report, gender is based on how physicians self-identified in our survey.
Some totals in this presentation do not equal 100% because of rounding.
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
At this still-early stage of adoption of AI algorithms in the medical workplace, 58% of practicing US physicians told Medscape they're not yet enthusiastic about AI's future.
"To see over 40% enthusiastic is great," says Eric J. Topol, MD, Medscape editor-in-chief and co-host of the Medicine and the Machinepodcast. "There's very little penetration of AI in the medical workplace yet, not a lot of data about it, so it's a very significant percentage."
Looking at a discrete group of medical specialties, cardiologists, anesthesiologists, and radiologists were likeliest among them to describe themselves as enthusiastic. Cardiology and radiology were among the first specialties where AI algorithms showed promise in diagnosis or treatment, according to one journal article.
Family physicians and pediatricians were most likely to tell us that they were apprehensive about AI's future role in their workplace.
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
A common perception is that younger people in the workforce, who have grown up with rapid-fire digital advances, view technology most positively. But here, doctors aged 45-64 were more often enthusiastic about AI's future in the medical workplace than were the youngest physicians.
"I was a little surprised by that," Topol says. But physicians approaching age 35 often have little to no time in practice yet, he points out. So, these doctors are at a disadvantage for assessing AI's future in their jobs.
At the other end of the scale, we found no significant difference by age in how often physicians described themselves as apprehensive about AI's future.
Also, there was no meaningful split in the attitudes of male and female doctors.
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
Much professional literature has emerged in the past few years seeking to calm the debate about AI's role in clinical decisions. "Although some envision a future where AI might perform more comprehensive clinical tasks, existing technologies and clinical workflows limit the likelihood that AI can effectively replace human physicians," according to a briefing paper sponsored by AMS Healthcare, a Canadian charitable organization.
Why is that? Complex clinical tasks require reasoning at multiple levels, whereas AI applications currently are better suited to a narrow band of diagnostic activities, that paper said.
Still, around 2 in 3 physicians told Medscape that they harbor at least some concerns about AI algorithms being substituted for their own clinical judgment and expertise.
Yair Lewis, MD, PhD, an internist and chief medical officer for Naviana, a New York–based start-up developing an AI-based platform for primary care, believes many clinicians worry that current iterations of AI would make faulty recommendations and drive up their legal liability. But also, he says, some doctors simply "are concerned about job security," and that colors their perceptions about AI's legitimacy in diagnosis and treatment.
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
In comparison to when they opined about AI as a possible substitute for their clinical judgment, doctors were more positive about AI in a support role.
Fifty-six percent of physicians described some level of enthusiasm about AI offering diagnosis and treatment options to supplement their recommendations, whereas 36% of them had little to no concern that AI might replace their clinical judgment and expertise (see slide 5). Forty-four percent of doctors had at least some apprehension about AI as an adjunct, and 65% voiced some concern about AI algorithms substituting for them (see slide 5).
The doctors whom Lewis encounters usually are more comfortable with AI at an autonomy level where they can only make recommendations, not at "level 4" (where technology can make certain decisions, but with human supervision) and above.
"But multiple studies have shown a hybrid approach combining AI with a clinician gets a better result than just a machine or just a human being," he adds.
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
Regardless of their feelings about AI's future role in their profession, the US physicians we surveyed were realistic about the need to stay current about how AI applications were being, or could be, used in medicine.
"I think this is the best marker of all" in the Medscape survey data, Topol says. "Physicians understand AI's importance even if they're not enthusiastic. There's no apathy here."
One journal article advocated for continuing education of physicians about AI's potential advantages and shortfalls, beginning in medical school.
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
The physicians whom Medscape surveyed said that their practices were more inclined to use AI for research or recordkeeping, administrative, or scheduling tasks than for crafting patient communications or to help with diagnostic or treatment decisions.
"These responses accurately reflect the penetration of AI platforms right now," according to Lewis. "Not many applications are making diagnoses or predicting a patient's outcomes." In another year or two, he believes, the story may be different.
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
Physicians more often said their practices would consider AI in administrative, scheduling, and recordkeeping tasks than in diagnosis and prognosis, detailed clinical notes, or patient communications tasks. But it's worth noting that at least half of doctors believed their workplaces would evaluate AI for each of the roles listed in the above chart.
"Physicians want AI to take away the more boring and tedious aspects of their job," Lewis notes. "It's interesting to me that this survey found concerns about AI in medicine as a general concept — but then when you start to ask about specific tasks, you see significant enthusiasm."
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
Doctors more often felt positively about AI's impact on administration and recordkeeping in medical office and hospital environments than on these other activities.
"I think this shows that physicians in the survey are keeping up and are in step with where progress is being made" with AI and medicine, according to Topol.
"Right now, the most exciting things happening will allow doctors to avoid being a slave to a keyboard. Using ambient voice technologies to create far better patient notes than are being made now, ordering tests, handling prescriptions, following up with patients…that's the most exciting near-term prospect."
As for why 1 in 4 physicians felt negatively about using AI to craft patient communications, one possible reason emerged from a previous Medscape survey that found doctors were concerned about how AI tools would handle private or sensitive patient information.
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
Two thirds of physicians in the Medscape survey said their medical employers should take a wait-and-see approach with AI, implementing algorithms only after bugs were worked out and reliability verified. Another 29% of doctors wanted their workplaces to be early adopters of AI, and 6% said they should avoid the technology.
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
Although Medscape's survey found US physicians felt positively about AI's impact on their administrative and recordkeeping tasks, they seemed to be in wait-and-see mode about whether more time would become available for patient conversations and care.
"Being unsure at this point is very reasonable," Topol observes. "They haven't felt or seen any time savings from AI yet. Plus, most physicians don't get to make the decisions on how much time to spend" with patients. "They have overlords, the 'bean counters,' who are making that call."
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
Eighty-eight percent of doctors in our survey said it was at least somewhat likely that patients turning to "generative" AI (capable of generating text, images, and other media) for medical information would get at least some misinformation.
"Today's iterations of generative AI aren't ready for broad use in healthcare" and "occasionally [provide] confident yet factually incorrect responses," Robert Pearl, MD, wrote in an April 2023 article for Forbes. But he is optimistic that AI developers will make the necessary adjustments.
As for Lewis, "I personally am not concerned at all" about the risk of patients gathering bad medical information along with the good. "Any information a patient gets will help…bring about an intelligent conversation, which puts the doctor-patient interaction in the right place.
"I think doctors should be excited that you can have an intelligent conversation with a patient about atherosclerosis, because they've already read about it by using a generative AI."
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
Around 9 in 10 US physicians were at least somewhat concerned that patients inclined to research their condition could side with AI-generated information over their doctor's recommendation.
Such apprehension is only fueled further by media coverage like the recent story about a mother who took her young son to 17 doctors over 3 years for his chronic pain, before turning to ChatGPT and receiving an accurate diagnosis of tethered cord syndrome.
In this regard, physicians might be worrying too much. A 2019 article in Harvard Business Review that reviewed then-current research found patients were "reluctant to use health care provided by medical artificial intelligence even when it outperforms human doctors. Why? Because patients believe that their medical needs are unique and cannot be adequately addressed by algorithms."
"It's the same thing we saw years ago with the advent of Google, when patients started research their condition on search engines, and doctors worried they would get faulty information," Topol says. "We've got uncertainties right now with AI 'large language' models" that mimic human intelligence, so I think being somewhat concerned is healthy."
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
The great majority of physicians in our survey said patients had not asked them whether the practice uses AI.
This seems to dovetail with a 2023 Pew Research Center survey that found 60% of patients felt uncomfortable with the idea of their medical provider using AI to make diagnoses or recommend treatments.
A majority (57%) of patients who did ask whether the medical practice relied on AI generally felt positively about that decision, doctors told Medscape.
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
A strong majority of physicians said AI's use in medicine needs oversight from government agencies and/or medical associations. This is not a new idea.
For example, the US Food and Drug Administration (FDA) already regulates some machine learning applications or software tools used in a clinical context that it considers to be "medical devices," and one journal article proposed a broader framework for FDA oversight of autonomous AI (A-AI) products in healthcare. And the American Medical Association earlier this year called for greater regulatory oversight of how insurers use AI to review claims and prior authorization requests.
"My view is that it definitely needs to be regulated," Lewis offers. At its core, AI "is a device, and it's in the public interest to oversee its manufacturers."
On the other hand, neither AI developers nor the public would be served by making companies reapply to the FDA every time an algorithm retrains itself using machine learning and new data, he says. "It's a very complex question."
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
How could using AI in diagnosis and treatment influence the risk for a malpractice claim? A doctor who turns to AI for assistance "in a case of high uncertainty" and then decides to deviate from that AI conclusion is exposed to legal risk if something goes wrong for the patient, a Johns Hopkins article said.
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
Medscape Physicians and AI Report 2023: A Source of Help or Concern?
Jon McKenna | October 30, 2023 | Contributor Information
Is Your Risk of Being Sued Climbing? Medscape Physicians and Malpractice Report 2023
A Medscape survey reveals the top reasons why physicians are sued for medical malpractice, amounts of successful claims and malpractice premiums, and how the experience affects their lives.Medscape News Slideshows, Oct 2023
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