Healthcare’s tidy hierarchy of specialties was formed by cognitive necessity. The corpus of medical knowledge is too massive for a single person to master and the clinical workforce was organized around it, but a new article in Health Affairs says it might be time for a redesign if AI removes that constraint.
AI is scaling specialist-level knowledge. Leading models are coasting through Board exams and polishing their clinical capabilities, which the authors argue will quickly scale specialist-level knowledge to the point where most specialty care can be delivered by PCPs.
- They coined the term “generalist-specialists” for a new category of doctors that transcends narrow specialty definitions.
Clinical expertise is increasingly democratized. The authors see a future where AI-augmented clinicians can manage the full constellation of patients’ chronic conditions within disease-based domains rather than organ-specific specialties. They give a few examples:
- Cardiometabolic Diseases – combines cardiology, endocrinology, and nephrology
- Infectious & Inflammatory – rheumatology, infectious disease, & gastroenterology
- Primary Care: spans OB/GYN, internal medicine, and pediatrics.
That could have some major benefits. Instead of shuffling a diabetic patient between an endocrinologist, cardiologist, and nephrologist, a generalist-specialist could manage the full cardiometabolic picture.
- That means fewer handoffs, faster diagnoses, and lower co-pays. It would also unlock a ton of specialty capacity for the patients that need it most.
- Consolidating care under fewer clinicians would also be a tailwind for value-based care, although it would likely increase utilization in a fee-for-service world by converting deferred, fragmented, or incomplete care into a cohesive billable treatment.
AI isn’t the only barrier to making that happen. Everything from med schools and malpractice standards to credentialing and referral systems would need to be completely overhauled.
- The generalist-specialist vision also assumes that specialists will be on board with either becoming quasi-PCPs or upskilling to ultra-complex care. Definitely not a given.
- Patient safety concerns also go without saying, but the AI will probably be pretty decent by the time we have cardio-endocrin-nephrologists putting together the care plans.
The Takeaway
AI could easily bring specialist knowledge to generalist fingertips, but if overworked PCPs are going to start also being OB/GYNs it will take more than a fancy LLM to get there.
