Artificial intelligence is moving fast — so fast that old questions about whether AI should be licensed to practice medicine, in whole or in part, have become pressing ones. These questions are arriving everywhere, in policy debates, pilot programs, and draft legislation, particularly at the state level.
The safest and most sensible answer today is that AI is not ready to be independently licensed like a physician. Medicine rests on a social contract: Society grants physicians unique privileges because they promise extraordinary duties of competence, ethics, and accountability in return. A medical license, therefore, 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.
The Federation of State Medical Boards, which we lead, occupies a unique position in this regard. While advisory, it serves all 69 state and territorial medical boards, which are statutorily charged with licensing and regulating physicians and, above all, protecting the public. From that vantage point, we view generative artificial intelligence 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.
Our role is to help boards navigate this emerging landscape by ensuring regulation keeps pace with innovation while promoting consistent, ethical standards for how AI is incorporated into clinical practice. At the same time, no responsible regulator can or should ignore the nation’s health care workforce crisis or the possibility that well-governed AI tools could help relieve administrative burdens, improve access, and allow clinicians across many specialties to spend more time with their patients.
In 2024, FSMB’s House of Delegates adopted a nonbinding policy guidance about the responsible incorporation of AI into clinical practice. The message — intended for medical regulators and licensed clinicians alike — was designed to be lofty and overarching, but balanced and practical. It 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. 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.
That principle matters because some policymakers are beginning to imagine a separate lane for licensing 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 in the first place reveals something important: 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.
There is a danger in treating medicine as just another commodity, a consumer service that can be split off into a new regulatory silo. Medicine is different because the stakes are different. A prescription refill, a triage recommendation, or a diagnostic suggestion may look routine until it is handled poorly and leads to harm. The public deserves clear lines of responsibility and recourse when that type of harm occurs.
Recent events in Utah show both the promise of AI and the need for industry to work with medical regulators when testing new approaches. The state’s Office of Artificial Intelligence Policy approved a 12-month pilot program with a health tech startup called Doctronic 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.
That approach is consistent with FSMB’s 2024 policy, which advised states exploring the application of AI in health care to work with their medical boards. The policy also said medical boards should examine how the “practice of medicine” is defined in their jurisdictions — especially as AI systems become more autonomous — and that FSMB should make itself available to work with state boards to develop such guidance. In other words, innovation and oversight should not be opponents. They should be partners.
That partnership is evolving fast. The FSMB is working with its medical boards, stakeholder organizations, ethicists, and AI experts to update its guidance. That is necessary because the existing framework was drafted before the newest wave of agentic systems pushed AI from passive assistance toward more autonomous action.
This debate will not stay confined to conference panels, of course. Federal and state lawmakers, governors, technology offices, and the public are already asking who should regulate increasingly autonomous systems in health care and whether those systems should ever be “licensed” to practice.
The answer should be informed by the institutions that already understand professional standards, clinical risk, and accountability in medicine: state medical boards. From FSMB’s perspective, that means carefully distinguishing between licensing human clinicians and authorizing, registering, or otherwise approving AI tools, while thoughtfully engaging with the increasingly complex questions raised when AI begins to perform clinical tasks with limited or no direct physician supervision. These are the issues our boards are facing today (see the Washington State AI Task Force) and one that our newly formed Workgroup on the Regulation of AI in the Practice of Medicine is tackling head-on.
As sociologist William Bruce Cameron wrote in his 1963 book “Informal Sociology: A Casual Introduction to Sociological Thinking,” “Not everything that counts can be counted, and not everything that can be counted counts.” That was during a corporate mainframe computing boom, while AI was still in its infancy. As AI systems grow more capable, the central task will be to preserve clear lines of human accountability, grounded judgment, and patient trust.
Humayun J. Chaudhry, D.O., M.S., is president and CEO of the Federation of State Medical Boards. Christy Valentine Theard, M.D., M.B.A., is chair of FSMB’s Board of Directors, and plan president for Anthem Blue Cross, Blue Shield Medicaid in New York.
