Implications for the healthcare workforce

Artificial intelligence (AI) and related technologies are increasingly prevalent in business and society, and are beginning to be applied to healthcare. These technologies have the potential to transform many aspects of patient care, as well as administrative processes within provider, payer and pharmaceutical organisations.

There are already a number of research studies suggesting that AI can perform as well as or better than humans at key healthcare tasks, such as diagnosing disease. Today, algorithms are already outperforming radiologists at spotting malignant tumours, and guiding researchers in how to construct cohorts for costly clinical trials. However, for a variety of reasons, we believe that it will be many years before AI replaces humans for broad medical process domains. In this article, we describe both the potential that AI offers to automate aspects of care and some of the barriers to rapid implementation of AI in healthcare.

To our knowledge thus far there have been no jobs eliminated by AI in health care. The limited incursion of AI into the industry thus far, and the difficulty of integrating AI into clinical workflows and EHR systems, have been somewhat responsible for the lack of job impact. It seems likely that the healthcare jobs most likely to be automated would be those that involve dealing with digital information, radiology and pathology for example, rather than those with direct patient contact.28

But even in jobs like radiologist and pathologist, the penetration of AI into these fields is likely to be slow. Even though, as we have argued, technologies like deep learning are making inroads into the capability to diagnose and categorise images, there are several reasons why radiology jobs, for example, will not disappear soon.29

First, radiologists do more than read and interpret images. Like other AI systems, radiology AI systems perform single tasks. Deep learning models in labs and startups are trained for specific image recognition tasks (such as nodule detection on chest computed tomography or hemorrhage on brain magnetic resonance imaging). However, thousands of such narrow detection tasks are necessary to fully identify all potential findings in medical images, and only a few of these can be done by AI today. Radiologists also consult with other physicians on diagnosis and treatment, treat diseases (for example providing local ablative therapies) and perform image-guided medical interventions such as cancer biopsies and vascular stents (interventional radiology), define the technical parameters of imaging examinations to be performed (tailored to the patient's condition), relate findings from images to other medical records and test results, discuss procedures and results with patients, and many other activities.

Second, clinical processes for employing AI-based image work are a long way from being ready for daily use. Different imaging technology vendors and deep learning algorithms have different foci: the probability of a lesion, the probability of cancer, a nodule's feature or its location. These distinct foci would make it very difficult to embed deep learning systems into current clinical practice.

Third, deep learning algorithms for image recognition require ‘labelled data’ – millions of images from patients who have received a definitive diagnosis of cancer, a broken bone or other pathology. However, there is no aggregated repository of radiology images, labelled or otherwise.

Finally, substantial changes will be required in medical regulation and health insurance for automated image analysis to take off.

Similar factors are present for pathology and other digitally-oriented aspects of medicine. Because of them, we are unlikely to see substantial change in healthcare employment due to AI over the next 20 years or so. There is also the possibility that new jobs will be created to work with and to develop AI technologies. But static or increasing human employment also mean, of course, that AI technologies are not likely to substantially reduce the costs of medical diagnosis and treatment over that time frame.

Artificial intelligence is not one technology, but rather a collection of them. Most of these technologies have immediate relevance to the healthcare field, but the specific processes and tasks they support vary widely. Some particular AI technologies of high importance to healthcare are defined and described below.