Opinion: The AI licensure debate is missing the point of licensure
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- Physicians retain sole accountability when AI tools enter clinical workflows — even when they override an algorithm's recommendation, the doctor signs the chart and faces the deposition
- Dent v. West Virginia (1889) established that physician licensure exists because clinical consequences require a person who can be examined, tested, and held accountable for their decisions
- Hawker v. New York (1898) added that character is as important as knowledge in defining a profession, because what members owe those they serve shapes the role
- Shinal v. Toms (Pennsylvania Supreme Court) held the physician's duty to disclose material risks is nondelegable — it cannot be handed to a colleague, nurse, or system
- AI has performed at or near the passing threshold on the United States Medical Licensing Examination, but the authors argue it cannot decide or bear responsibility for its clinical output
- Afnan R. Tariq, M.D., J.D., co-chair of the SCAI Artificial Intelligence Task Force, and Ami B. Bhatt, M.D., chief innovation officer of the American College of Cardiology and chair of the FDA Digital Health Advisory Committee, authored the opinion
Why it matters: The authors — who lead AI policy at the SCAI, the American College of Cardiology, and the FDA's Digital Health Advisory Committee — are directly shaping how AI enters cardiology. Their argument carries weight because the legal duty of care, affirmed across four cited cases, cannot be transferred to software, meaning every hospital deploying AI diagnostics must keep a licensed physician as the accountable decision-maker or absorb the liability themselves.
