State Medical Boards Say AI Is Not Ready for Independent Licensure, Urge Physician Accountability

Artificial intelligence is not ready to be independently licensed like a physician, according to the Federation of State Medical Boards (搜索)搜索该词条 (FSMB), which serves all 69 state and territorial medical boards statutorily charged with licensing and regulating physicians and protecting the public. In a position articulated by FSMB President and CEO Humayun J. Chaudhry, D.O., M.S., and Board Chair Christy Valentine Theard, M.D., M.B.A., the organization argues that medicine rests on a social contract in which society grants physicians unique privileges because they promise "extraordinary duties of competence, ethics, and accountability in return."

A medical license, the FSMB leaders write, "isn't just a permit to generate thoughtful and informed answers. It's a legal and ethical grant of authority tied to human judgment, professional accountability, discipline, transparency, and a duty to put patients first." From this vantage point, the FSMB views generative AI as "a powerful tool that should be governed within existing professional and institutional accountability structures, with responsibility aligned to its level of autonomy and human oversight, rather than treated as a separate 'practitioner' licensed like an individual clinician."

The 2024 Policy Framework

In 2024, FSMB's House of Delegates adopted nonbinding policy guidance on the responsible incorporation of AI into clinical practice. The guidance encourages the use of AI by physicians when it can improve care and advises documentation of its use, but cautions that professional responsibility remains with the licensee. As the FSMB leaders explain, "State medical boards do not regulate machines or tools and are not set up to do so. They regulate the physicians who use them, and state medical boards believe physicians should remain accountable for harms caused by inappropriate reliance on AI."

This principle has taken on new urgency as policymakers begin to imagine a separate regulatory lane for autonomous systems. Proposed legislation this year in Idaho and Iowa raised the possibility of creating a state licensing board for "autonomous service providers" that would sit apart from each state's long-standing state medical board. Both bills failed, but their introduction signals a shift: "We are past the point of wondering whether someone will propose licensing AI like a human physician. The question now is who will decide, under what authority, and whether they have a legitimate understanding of the practice of medicine and the impact autonomous AI in health care brings."

The Case for Human Accountability

The FSMB position is reinforced by clinicians who argue that licensure has never been merely about passing a test. 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 (搜索)搜索该词条 and chair of the FDA Digital Health Advisory Committee, contend that licensure "is about bearing responsibility for the outcome."

They trace this principle through legal history, citing the Supreme Court's 1889 decision in Dent v. West Virginia, which upheld physician licensure on the grounds that "clinical consequences require a person who can be examined, tested, and held accountable for their decisions." Nine years later, in Hawker v. New York, the Court held that character is as important a qualification as knowledge. More recently, in Canterbury v. Spence, the U.S. Court of Appeals for the D.C. Circuit held that the physician's duty to disclose material risks "belongs to the physician alone," and in Shinal v. Toms, the Pennsylvania Supreme Court held that this duty is nondelegable.

The authors describe a scenario in which a cardiologist reviews an echocardiogram flagged by an algorithm she did not choose, trained on data she has never seen, deployed by a health system that did not ask for her input. If she overrides the algorithm and the patient does well, "no one will remember this moment." But if she acquiesced and the patient suffered harm, "she would be the one in the deposition, with her license on the line. Not the engineer who built the algorithm. Not the vendor who sold it. Not the health system that deployed it."

This asymmetry, they argue, is structural: "The algorithm performs the analysis. The vendor captures the billing. The payer deploys the tool that decides what care gets authorized. The health system licenses the product into the workflow. Each actor takes a piece of what was once unified in one person: the clinical decision. Each captures value from it: billing, attribution, outcomes data, market position. But the accountability stays, whole and undiluted, with the physician."

The Utah Pilot and the Path Forward

Recent events in Utah illustrate both the promise of AI and the need for industry to work with medical regulators. The state's Office of Artificial Intelligence Policy approved a 12-month pilot program with a health tech startup called Doctronic (搜索)搜索该词条 to automate the routine guideline-based prescription renewals of 192 commonly prescribed drugs under strict parameters and physician oversight. The arrangement drew the attention of Utah's medical licensing board, underscoring that "even when innovation lawfully moves through a state's AI apparatus or sandbox, the medical board must have a say when clinical decisions and patient safety are involved."

This approach is consistent with FSMB's 2024 policy, which advised states exploring AI in health care to work with their medical boards and recommended that boards examine how the "practice of medicine" is defined in their jurisdictions as AI systems become more autonomous. The FSMB is now updating its guidance in collaboration with medical boards, stakeholder organizations, ethicists, and AI experts, a process made necessary because the existing framework "was drafted before the newest wave of agentic systems pushed AI from passive assistance toward more autonomous action."

The FSMB leaders caution against treating medicine as "just another commodity, a consumer service that can be split off into a new regulatory silo." They note that a prescription refill, a triage recommendation, or a diagnostic suggestion "may look routine until it is handled poorly and leads to harm," and that the public deserves clear lines of responsibility and recourse when such harm occurs. As the debate moves beyond conference panels to federal and state lawmakers, governors, and technology offices, the FSMB maintains that the answer "should be informed by the institutions that already understand professional standards, clinical risk, and accountability in medicine: state medical boards."

For clinicians, the path forward is clear. As Tariq and Bhatt write, "AI will reshape medicine. The physicians who answer for the outcome must lead the way it enters patient care. That has always been the price of being a professional. It has also always been the point."