Can Your Doctor Really Provide the Care You Need Without Adopting AI Assistants?
Revolutionizing Healthcare: Using AI to Cut Physician Workload
According to historical records, the first documented instance of a diagnosis and treatment by a doctor is found in the Edwin Smith Papyrus, an ancient Egyptian medical text attributed to Imhotep, dating back to the Third Dynasty of Egypt around 2630-2611 BC; essentially marking the beginning of recorded medical diagnosis and treatment practices.1 For thousands of years physicians have treated patients one at a time by listening to their symptoms, examining them, making a diagnosis, and prescribing a treatment. Even documentation of medical records was unchanged for centuries until the advent of electronic health records just a few years ago.
Administrivia Adds to Each Doctor’s Day
With the adoption of electronic medical records (EMR), doctors have become data entry clerks. As discussed in Case #1 – Episode 3, Why Your Doctor Won’t See You Now , EMRs introduced a significant documentation burden for physicians. The primary purpose of EMRs is to facilitate billing and reimbursement rather than to enhance patient care. The documentation required for insurance reimbursement, combined with new government regulatory requirements, has add hours to a physician’s workday.
Routine patient interactions, such as prescription refills, simple treatments, referrals, and medical advice—which were once managed by nurses through verbal orders—are now electronic messages requiring physician approval. Moreover, risk managers emphasize, “If it isn’t documented, it didn’t happen,” leading to excessive “note bloat” as physicians document extensively to protect against liability and increase collections. This documentation overload, as demonstrated in Why Your Doctor Won’t See You Now , further consumes physicians’ time reducing their availability for direct patient care.
Balancing Preventive Care and Physician Responsibilities
Dr. John Bachman, Saunders Professor of Primary Care at the Mayo Clinic, illustrates the expectations placed on physicians: “The good doctor sees an adult patient who has caught strep throat from a school-age child and sends them home with a penicillin prescription, a referral for colon cancer screening, and an appointment for their tetanus/pertussis vaccination.”
Medical advancements have expanded the range of preventive measures available to maintain patient health. The Affordable Care Act (ACA) mandates that health insurers cover preventive services recommended by the U.S. Preventive Services Task Force (USPSTF). However, while the ACA promotes preventive care, it does not specify reimbursement guidelines for physicians.
Determining appropriate preventive measures for patients based on gender, age, and risk factors requires considerable effort. Yet, compensation for preventive services remains minimal under private insurers, placing the financial burden on primary care physicians. This time-consuming aspect of care is often deprioritized in favor of higher-reimbursement chronic disease management.
The Growing Time Crisis in Primary Care: Why Physicians Can’t Keep Up
The American Medical Association (AMA) has studied the time required for a physician with a typical patient panel of 2,500 individuals to provide care in accordance with best practices while meeting all regulatory requirements. Their 2005 findings2 shown in Figure 1 revealed that adhering to practice guidelines for just 10 chronic illnesses would require more time than primary care physicians could allocate to patient care overall.3
At that time, researchers concluded that no clinician could meet all care guidelines within a feasible workday. They recommended streamlining guidelines and adopting alternative methods of medical services delivery, yet those recommendations were ignored. As a result, the time pressures on physicians have only worsened and physicians are burning out.
In 2022, researchers replicated the 2005 study to reassess primary care physicians' workload shown in Figure 2.4 Their findings reflect increased time requirements due to expanded preventive care recommendations, including additional cancer screenings, new vaccines, and the growing demand for counseling services related to addiction and mental health disorders.
Beyond acute and chronic care responsibilities, physicians must now manage an additional three hours per day of unreimbursed documentation and electronic medical record (EMR) communications described above. To maintain a 12-hour workday, the time available for chronic disease management decreased by 33%, and time for acute care patients was cut nearly in half. These patients are often diverted to less experienced providers, as explored in Case #1 – Episode 10, What Provider Will You Get .
Revolutionizing Healthcare: How AI Can Cut Physician Workload and Improve Patient Care
The advent of artificial intelligence systems offers hope for correction of each of the problems that have lengthened the doctor’s day to the obviously impossible 20+ hours. Some of the regulatory changes that I recommended in The Assassination of United Healthcare’s CEO could expand technology use. Artificial intelligence agents could free physicians from undue burden.
Let’s consider how AI agents could immediately impact care.
1. Acute Care
The Value Health conditions outlined by Clayton Christensen in The Innovator’s Prescription: A Disruptive Prescription for Health Care5 and discussed in What Healthcare Provider Do You Need can be effectively managed using existing artificial intelligence agents. Patients could access automated treatment for conditions such as sinusitis, female cystitis (urinary tract infection), influenza, seasonal allergies, and erectile dysfunction directly through a doctor’s website. I have personally developed web-based AI-driven systems that have been proven as safe as face-to-face doctor visits and have been operational since the late 1990s.6 However, due to outdated state and federal regulations designed to protect doctor visits, these systems remain undeployable in the U.S. A physician in Northern Ireland, void of such restrictions, reported the system decreased the time primary care physicians spent on acute patient needs by 75%.7
2. Chronic Disease Management
Smart devices are now widespread and highly accurate, enabling patients to monitor vital signs and other health metrics from home. By combining in-home monitoring with expert AI-administered interviews, many well-managed patients could reduce their quarterly office visits to just an annual checkup. Integrating AI agents with home-based devices and electronic health records could significantly streamline chronic disease management, potentially reducing physicians' workload by 50% according to Dr. John Bachman.8
3. Preventive Care
Preventive care has been neglected for decades due to the lack of insurance reimbursement, making it challenging to address the myriad of patient needs swiftly. AI agents could play a pivotal role in extracting information from electronic medical records, screening patients with AI interview software, and recommending appropriate care. For instance, AI agents can remind patients to get PAP smears every three years to prevent cervical cancer. They would know that PAP smears are not indicated for women under 21, those who have had a total hysterectomy with cervix removal, or women over 65. However, the AI agents would remind women to get a PAP smear more frequently if they had a history of abnormal PAP results, HIV positivity, weakened immune systems, or exposure to diethylstilbestrol (DES) before birth. Perhaps 90% of prevention could be managed by AI agents but this is my hypothesis based on unpublished research.
4. Documentation and Regulations
Electronic medical records should function in the background as a byproduct of the office visit, not as the physician’s primary focus. Currently, many clinicians spend excessive time typing during patient encounters or documenting afterward, detracting from direct patient care. The ideal use of electronic health records is illustrated in Case #1 – Analysis 4, What Should a Medical Office Visit Be Like? AI-powered patient interview systems can generate 70% of the necessary documentation automatically, using patient-provided data. Additionally, AI agents can transcribe verbal or written notes from the physician, creating visit summaries and completing electronic health records with minimal human input.
Routine patient interactions, such as prescription refills, simple treatments, referrals, requests for referrals and medical advice could be easily handled by artificial intelligent agents.
Summary
The technology now exists to help doctors manage their currently impossible day.
Only a disruptive technology like artificial intelligence can meet the need that doctors have today to care for patients. Figure 3 shows how AI agents might help primary care doctors do their job. Good software should be indistinguishable from magic.9
Preview
The roles of primary care physicians, family doctors, internists, and obstetrician-gynecologists have become unsustainable. In the next essay, we will explore the issue of physician burnout. Without meaningful change, the anticipated doctor shortage will be far more severe than currently projected. This discussion aims to highlight the urgent need for critical workflow improvements in medical offices to prevent a healthcare crisis that will result in premature deaths among U.S. citizens.
THE FIRST PHYSICIAN. JAMA. 2009;302(7):807. doi:10.1001/jama.2009.1156
Østbye T, Yarnall KS, Krause KM, Pollak KI, Gradison M, Michener JL. Is there time for management of patients with chronic diseases in primary care?. The Annals of Family Medicine. 2005 May 1;3(3):209-14.
Yarnall KS, Pollak KI, Østbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention?. American journal of public health. 2003 Apr;93(4):635-41.
Porter J, Boyd C, Skandari MR, Laiteerapong N. Revisiting the time needed to provide adult primary care. Journal of general internal medicine. 2023 Jan;38(1):147-55.
Christensen, C., Hwang, J. and Grossman, JH. The Innovator's Prescription: a Disruptive Solution for Health Care. New York: McGraw-Hill, 2009
Munger, M. A., Stoddard, G. J.; Wenner, A. R.; Bachman, J. W., Jurige, J. H., Poe, L; Baker, D. L., Safety of Prescribing PDE-5 Inhibitors via e-Medicine vs Traditional Medicine, Mayo Clin Proc. August 2008;83(8):890-896
Communication Tom Black, Derry City, Northern Ireland reported in Royal College of General Practitioners Journal 2017
Personal communication, John Bachman, MD, Sanders Professor of Primary Care, Mayo Foundation, Rochester, MN.
Arthur Clark, in his 1962 book Profiles of the Future and discussed in https://lab.cccb.org/en/arthur-c-clarke-any-sufficiently-advanced-technology-is-indistinguishable-from-magic/#:~:text=In%201962%2C%20in%20his%20book,technology%20is%20indistinguishable%20from%20magic%E2%80%9D.