When I moved states as a seasoned physician associate, I anticipated a seamless transition into clinical practice. Instead, I encountered a rigid and paradoxical licensing and regulatory system that, unintentional or not, hindered workforce recruitment. This reflective article explores how this experience reignited my commitment to professional advocacy and contributed to the successful passage of the 2025 Physician Associate Practice Modernization Bill. Through personal narrative and critical reflection, this paper examines the systemic barriers faced by physician associates, the emotional toll of bureaucracy, and the transformative power of sustained, relationship-based advocacy. Licensing barriers for physician associates further exacerbate the US healthcare workforce shortage, despite a lack of evidence that they improve patient outcomes. My journey highlights how policy engagement is not an optional add-on to clinical roles but a professional imperative when the system fails to serve both clinicians, their communities, and, ultimately, their patients.
]]>As the use of artificial intelligence in professional practice and everyday life continues to expand, there are increasing questions regarding the role of health professions' regulators in ensuring responsible adoption of this technology by practitioners. Ensuring safe and effective professional practice is a primary mandate for regulators; it is currently not clear how artificial intelligence may impact the work and role of professionals, particularly when human-out-of-the-loop artificial intelligence becomes more prevalent in professional work. This Commentary explores competing perspectives on what role—if any—health professions' regulators have in using regulatory tools and approaches to manage the proliferation of artificial intelligence in professional work. It examines the current regulatory ecosystem (of which professions' regulators are a part) and highlights opportunities for potential collaboration across different regulatory sectors to better safeguard interests of patients and practitioners alike.
]]>With the rapid evolution of artificial intelligence, the work of health care professionals is changing quickly. Both human-in-the-loop and human-out-of-the-loop artificial intelligence are becoming prevalent in patient care, and this raises questions regarding the role of health professionals' regulators in ensuring safe and effective practice and safeguarding the public's interests.
This research explored regulators' perspectives on whether and how regulatory tools could (or should) be used with respect to artificial intelligence.
An artificial intelligence-enabled search of websites identified regulatory leaders with respect to regulation of artificial intelligence. Eighteen regulators from diverse health professions in the US, Canada, and the UK were interviewed, based on their documented work in this area.
Key findings included: a) recognition that the rapid evolution of artificial intelligence was eclipsing regulators' abilities to manage it; b) belief that current regulatory tools were sufficient to manage risks of human-in-the-loop artificial intelligence, c) belief that regulation of human-out-of-the-loop artificial may be infeasible for regulators; and d) focus on development of educational, principles-based guidance to support practitioners in responsible adoption of artificial intelligence in their practice (rather than a rules-based approach).
As artificial intelligence continues to evolve rapidly and permeate professional and daily life, further research is necessary to ensure public interests are safeguarded effectively, in ways that do not stifle technological innovation and growth.
State Medical Boards are public entities authorized to issue licenses to qualified physicians to practice. They are also authorized to investigate complaints, to press charges and to sanction licensees. Applications for licensing, privileging, or credentialing (at the state/facility/insurance level) often include questions about complaints and investigations, purportedly to assess moral character and fitness to practice.
Primary license applications for MD/DO candidates from 50 US states, two US territories, and the District of Columbia from 2021/22 and 2023 were reviewed for questions relating to complaints, investigations, and discipline. States and territories were categorized into three tiers of professional and moral character questions based on number and quality of such questions. Nine representative state databases (three states from each tier) were then queried for their total number of complaints, investigations, and final adverse disciplinary actions/sanctions. Two years of data were queried for each of these nine states. The number of sanctions was then compared to the number of physician complaints and investigations. The three groups of states were then compared to each other to assess if harm reduction was proportional to number and depth of moral character questions.
Ten state medical boards inquired about any complaint ever lodged against the physician, while 27 state medical boards asked about current investigations. One medical board inquired about complaints or investigations over the past five years, 31 medical boards inquired about any investigation during clinical practice, and 26 medical boards queried investigations during training (school/residency/fellowship).
Sixteen medical boards asked about charges stemming from investigations; 42 medical boards asked about discipline/sanctions and two medical boards refused to consider a physician application if they are under investigation in another state. Three medical boards asked no questions about charges, or investigations.
Across all states and territories, 4% of complaints resulted in discipline/sanctions, impacting 0.28% of the physician population, regardless of the depth of moral character (number/type) application questions.
This data confirms that questions about complaints and investigations are unlikely to identify physicians with moral or quality issues and may cause professional and personal harm to applicants and licensees. Such a low rate of final disciplinary actions raises concerns about the justification of medical board inquiries about unadjudicated allegations, complaints, and investigations, per se, instead of limiting queries to actual sanctions/discipline applied. While final disciplines/sanctions should continue to be disclosed, consistent with the Federation of State Medical Boards and National Practitioner Data Bank guidelines, questions regarding complaints and investigations should undergo critical review and be removed from these applications (primary and renewal), as there was no correlation with patient safety and may be illegal. Additionally, universal codification of terms should be applied to maintain fair and legal disclosures.