Opinion: The AI licensure debate is missing the point of licensure

OpinionFirst Opinion The AI licensure debate is missing the point of licensure Licensing is about much more than passing a test Manage alerts for this article Email this article Share this article By Afnan R. Tariqand Ami BhattJuly 8, 2026 Tariq is co-chair of the SCAI Artificial Intelligence Task Force, and a CPT and RUC adviser. Bhatt serves as chief innovation officer of the American College of Cardiology and chair of the FDA Digital Health Advisory Committee. 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. The algorithm recommends a diagnosis. She disagrees. She overrides it. The patient does well. No one will remember this moment. But if she had 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.Advertisement Her name in the chart. Her judgment. Her license. Her. That is the system, and it reflects something fundamental about the profession of medicine. The emerging conversation about AI licensure is missing something essential, something deeply, inextricably human. Licensure has never been about just passing a test. It is about bearing responsibility for the outcome. AI will reshape how clinical decisions are formed. The question is who answers for the decision based on that output — and who is responsible for that decision when something goes wrong. A profession exists because of an asymmetry the patient can never close. The patient cannot evaluate whether the stent was placed correctly or the drug dosed properly. The Supreme Court understood this in 1889 when it upheld physician licensure in Dent v. West Virginia: 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 Supreme Court went further: Character is as important a qualification as knowledge, because a profession is defined not only by what its members know but by what they owe to those they serve.Advertisement That is what professionalism means, what it requires. It is not a credential alone. It is a continuing personal obligation. A physician can be deposed and required to explain their reasoning under oath, sanctioned by a board of professional peers, and held to a fiduciary duty that courts have called a relationship “of the highest degree” — because that is what the patient’s vulnerability demands of the professional, the physician. 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. It is personal, affirmative, and cannot be satisfied by proxy. In Shinal v. Toms, the Pennsylvania Supreme Court held that this duty is nondelegable: It cannot be handed off to a colleague, a nurse, or a system. It belongs to the physician because only the physician can be held to it. It is the summation of knowledge, experience, and responsibility that define a professional. Passing a test confers a credential. The profession is earned in the years after, in the decisions made under uncertainty, in the outcomes carried personally. The courts have entrusted professionals to self-govern, because they know what competent practice looks like, and because they understand the weight of decisions made in the care of another human being. They know the responsibility that comes with the public’s trust and with the trust of patients and families. Now, AI is entering medicine, and it has performed at or near the passing threshold on the United States Medical Licensing Examination. It can compute and inform, but can it decide and bear the responsibility of its output? 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.Advertisement But the accountability stays, whole and undiluted, with the physician. None of this is new. The law has answered these questions before, each time a new technology reshaped clinical practice. When imaging moved from the bedside to the reading room, the physician signed the report. When electronic health records automated order entry, the prescribing physician still bore the duty. When telemedicine extended care across state lines, the physician-patient relationship — and its obligations — followed. There is a reason the action requires a physician’s signature: responsibility. The technology evolves, but accountability remains with the clinician. Licensure has always required a person, because people can be held responsible. A person who can be examined, sanctioned, and found wanting. She who can be deposed and required to answer for her reasoning under oath. He who can hold a fiduciary duty, because a duty requires a relationship, and a relationship requires someone, a person, who can be held. The law has always placed a human being at the center of clinical accountability. It still does. Many of us leading the charge of expanding access to cardiovascular care want AI in cardiology. We want its ability to detect, triage, personalize, and scale care in ways our current systems cannot. But we also embrace what no algorithm, vendor, payer, or system has ever accepted in full: personal responsibility for what happens to the patient. 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. Afnan R. Tariq, M.D., J.D., is co-chair of the SCAI Artificial Intelligence Task Force, and a CPT and RUC adviser. Ami B. Bhatt, M.D., serves as chief innovation officer of the American College of Cardiology and chair of the FDA Digital Health Advisory Committee. Opinions are their own. Letter to the editor Have an opinion on this essay? Submit a letter to the editor. Artificial intelligence, Physicians, Policy Submit a correction requestReprints Afnan R. Tariq Ami Bhatt Newsletter The smartest thinkers in life sciences on what's happening — and what's to come Recommended Neurotransmissions July 8, 2026 STAT Plus: What’s the right role for AI in dementia care? First Opinion July 7, 2026 Medicine thinks Gen Z is too soft. It’s wrong Advertisement First Opinion July 7, 2026 What if this Ebola outbreak can’t be stopped? 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