Discussion

CEO of America’s largest public hospital system says he’s ready to replace radiologists with AI

Shank: > “For women who aren’t considered high risk, if the test comes back negative, it’s wrong only about 3 times out of 10,000,” Lubarsky said.I mean, if I were a choosing person and I could choose to have a human radiologist review AND an AI review I think I would prefer that. 3/10,000 sounds like a very good rate but a false negative on a cancer diagnosis is life threatening, no?

jon-wood: "The AI is wrong only 3:10,000 times" is a statement screaming out for the follow up question "how often are the humans wrong". Maybe 3:10,000 is astonishingly good, maybe humans are 10x or 100x better, right now I have no real way of knowing short of a literature review in a field I know nothing about.

GerryAdamsSF: He is blatantly and obviously lying likely to boost stock prices. Radiologists do physical procedures too.

jacknews: Surely they could offer a cheaper 'unregulated, no guarantee' AI interpretation with a confidence rating, and an optional follow-up 'are you sure?' expert assessment at full price.OTOH they're probably planning to charge full price anyway, but massively reduce costs, because, profit.

zamadatix: At a certain point the false positives start creating more harm than trying to further reduce the false negatives (which is, perhaps counterintuitively, eventually true for even the most serious of risks). Whether that's the case here depends on a lot of information not in the article.

luma: Brother-in-law graduated med school in the early 90s and has been a practicing ER physician since. We discussed this recently and he related that his advisors told him not to go into radiology back in the late 80s because the assumption was that computers were going to take over the field. He's not too far away from retirement and it's only now that we're starting to see some signs of this prediction from 30+ years ago.As others in the thread note, there are plenty of concerns around operational use of AI solutions in the medical space, but radiology has a much larger target painted on it than other practices as a fair portion of the job (but certainly not all!) can boil down to high-skill pattern recognition from visual inputs. The current list of AI-enabled devices going through FDA approval is public, more than 3/4 of the list are targeting radiology use cases: https://www.fda.gov/medical-devices/software-medical-device-...

cbg0: > Sandra Scott, MD, CEO of the One Brooklyn Health, a small hospital facing tight margins, agreed with this line of thinking, according to Crain’s.Does this CEO of a small hospital realize that their hospital will take the legal responsibility if there's no doctor to sue for malpractice?

catapart: Speaking of which... when people talk about "replacing" humans with AI, it makes me wonder if there's some kind of law we can push for that says "if you are part of the chain of command that signs off on AI being able to make final determinations, and that causes legal issues, you will be legally liable in place of the AI, since computers cannot be liable." Let a jury decide who, in the chain, bears what burden, case by case, but provide for prima facie liability for all parties in the chain, when a valid suit is tried. I want to see how strong the push is for AI when it's the CEO's personal money on the line.

bradreaves2: I figured this was “CEO said a thing” journalism [1], but buried in the last paragraph is a real scorcher:> “Undeniable proof that confidently uninformed hospital administrators are a danger to patients: easily duped by AI companies that are nowhere near capable of providing patient care,” [Radiologist Dr.] Suhail told Radiology Business. “Any attempt to implement AI-only reads would immediately result in patient harm and death, and only someone with zero understanding of radiology would say something so naive. But in some sense, they’re correct: Hospitals are happy to cut costs even if it means patient harm, as long as it’s legal.”[1] https://karlbode.com/ceo-said-a-thing-journalism/

RA_Fisher: That’s good, reducing healthcare costs will increase access and boost the our health.Agree that AI should replace CEOs. They’re often biased in unhelpful ways that AI isn’t and it costs people wellbeing.

mrtksn: Why AI is able to do everything except CEO and social media hype up work? Why engineers and doctors still need CEOs to do their job?I mean, apparently there are close to 400 million companies in the world, of those 60K are publicly traded.I am sure that there's an enough data to train top notch CEO on this, since they are required to keep records all the time.

SV_BubbleTime: With a little extra irony, I’m honestly certain our HR dept could easily be replaced with AI to far better effect. They would surely disagree.

squidhunter: When can we start replacing CEOs with AI?

rickydroll: I don't think AI is ready to replace CEOs, but it would make a good assistant for an H-1B CEO.

mrtksn: The job description should be sufficient prompt to replace the HR, add some RAG and skill files based on a few months of in-company chat tool data and paperwork, I don't see why there's still HR around. The AI HR can choose to hire entertainers etc. for some tasks but why would keep HR on payroll al the time?

compounding_it: If hospitals are so concerned about cutting costs, getting sued is probably worse. However they are all insured against malpractice. I would be careful about insurers who could default if they find too many malpractice claims.

elephanlemon: >amid rising demand for imagingOkay so demand for imaging is up, so we should GET RID of the radiologists? How about we AUGMENT them with AI so that they can do their job better and faster? Why does it need to be either or?

storus: Currently they are augmenting them with Indian radiologists and just sign off whatever they found.

seesthruya: Here we go again. There's something about radiology that makes it the perfect bait for nerd sniping. I guess it's probably the misunderstanding that it is exclusively pattern recognition.Here are my opinions, after a 20 year career as a diagnostic radiologist, and 45 years as a hobbyist computer programmer1. There are no products currently on the market that can replace a radiologist.2. If you can't fully and completely replace radiologists, you will still need them around in significant numbers.3. Because of the infinite variation in human anatomy, physiology, and pathology, it is my opinion that AGI will be required to fully and completely replace radiologists.4. Once AI is strong enough to replace radiologists, it will be strong enough to replace every other job as well.5. Based on current RVU compensation models, any cost savings achieved by hospitals replacing radiologists with AI will quickly be lost by reimbursements being adjusted down. There is no way an insurance company will pay the same for an AI interpretation and a human interpretation.6. There are significant unanswered medicolegal questions that will need to be addressed before AI can operate unsupervised.In conclusion, I will work as a human radiologist until I retire in 10 years

storus: The issue with radiologists is that on average they are able to spot ~35% of correct diagnoses, while the world's best radiologists ~45%. AI might get us to ~50% which is ~15% better than an average radiologist (who still needs to review it).

voidUpdate: > "and is “actually better than human beings,” he told the audience.“For women who aren’t considered high risk, if the test comes back negative, it’s wrong only about 3 times out of 10,000,” Lubarsky said. "What's the false negative rate for human beings? And what about women that are considered high risk? Is it better or worse?

saintfire: Not sure AI is ready to replace anyone but that doesn't seem to be the road block.

storus: How about we started replacing all companies that are replacing humans with AI using AI as well? As they decided to one-way participate in the economy (suck the money, not give anything back), we can make sure the one-way trend is done with rapidly. The cost of running a company will approach zero in the future. We now have massively profitable companies that are making record layoffs; something doesn't compute.

Forgeties79: Where are you getting these numbers? Even a cursory search doesn’t put the numbers anywhere near such poor performance by real people.AI at 50% would be notably worse (also where are you getting that number?)

storus: From radiologist AI training datasets, evaluated long-term/post-mortem.

coldtea: Anything to please the stockholders. It's not like patient's best interests mattered much to them before AI either.

parliament32: If anyone is replaceable by AI, executives are first in line. Make "decisions" based on expert input, give presentations, sit in meetings and on calls. No liability, no concrete "work product" to speak of, so why not?

Betelbuddy: And you are going to provide the references that will sustain this opinion, so we can elevate it to a fact...

georgeecollins: It would be interesting to start a co-op or non-profit run by AI for the benefit of the employees and customers. If it worked it would have a huge competitive advantage. I guess the question is where would the capital come from, but as a co-op the employees could buy in and just take the profits as a distribution.Thinking about this some more: US tax laws really favor income from investment over income from wages. So ideally a co-op member would put something in to join, get a wage, and have an appreciating asset in a tax advantaged account.

storus: Something like that. I'll try to do it as a side project next as I have some spare compute and ran 99% automated e-commerce companies before.

ricardobayes: To be frank I'm more concerned about non-litiguous countries here as the potential downsides are much lower to roll-out "AI radiologists". Some of those countries have multi-month or even year-long waitlists for specialist consultations so it might even be more tempting from a healthcare management level.

_dark_matter_: For folks with long wait times, maybe the advantage of "immediate access to AI radiologist" beats out "wait for human radiologist"? Would be interesting to weigh those harms against each other.

WarmWash: I stand to be corrected, but last time this cropped up about a year ago, there was a pretty severe mismatch in the use of the word "AI".The NYT ran a story about "AI taking over radiology", where they talked to radiologists at the Mayo clinic (who have an AI research lab), who flatly told NYT that no - AI will not be replacing radiologists, the AI is not good enough.Here is the rub though, the "AI Lab" was doing research using local CNN's with ~30M parameters. Basically 2017 consumer GPU tier AI tech.I don't know yet if there has been a modern transformer of datacenter scale that has been explicitly pre-trained for medicine/radiology, along with extensive medical/radiology RLHF.

Cthulhu_: Isn't it also in the insurer's best interest that the hospitals do good work? They'd be another force against hospitals using AI to diagnose or misdiagnose people.Of course, given that these are legal cases, it would take years for any consequences to be turned into actions.

dist-epoch: This works in the other direction too - a human mises a cancer, that 10 out of 10 radiology models say it's there with 99% confidence. That hospital will lose in court for negligence.

cbg0: Is this the norm in US courts, evaluating a human's performance against LLMs?

orwin: Maybe radiologist mean something different in my country, but here radiologist don't diagnose (i mean, except you see them for a broken bone or something), oncologist do. I did an observation internship with a radiologist when i was 20 (95% of my family are doctor/nurses/PT, i wanted to know what a degree in physics could help me do in the field, and radiologist was the only path to medecine from my initial formation where i only lost a year, and not two). You spend your time calculating doses, finding patient history, and calibrating machines, it's much more a technician role than a MD. In any case, and even if in the US radiologist diagnose cancer, that's such a small part of their job it shouldn't matter.

camdenreslink: I have seen very conflicting data on this. You shouldn’t state it so confidently.

emceestork: Hospitals already usually pay for malpractice insurance on behalf of the physicians.

devilbunny: They do, but it’s the physician who is personally liable, not the hospital. It’s just another form of compensation.My wife and I are both physicians. Our house doesn’t belong to either of us, strictly; it belongs to our marriage. You have to have a legal claim against both of us to put it in jeopardy.

freejazz: If it is a regular practice of such doctors to use such tools, and that doctor did not, then it is malpractice. That is how malpractice works. You have to fall below the standard of care in a way that proximately caused the damages.

amluto: I find the whole field of radiology to be utterly baffling. There are doctors who specialize in, and hopefully understand, specific diseases and/or parts of the body. But we have radiologists who are supposed to be able to look at images, taken by quite a variety of technologies and parameters, of any part of the body, and are expected to accurately interpret the findings, possibly without any relevant context.In my personal experience interacting with the medical system, it’s, unsurprisingly, quite common for an actual specialist to look at the same images a radiologist looked at, and see something quite different. And it’s nearly always the case that a specialist or a reasonable careful non-specialist who is willing to read a bit of the literature or even ask a chatbot [0], will figure out that at least half of what the radiologist says is utterly irrelevant.So I think that the degree to which ML can perform as well as a radiologist is not necessarily a great measurement for ML’s ability to assist with medical care.[0] Carefully. Mindlessly asking a chatbot will give complete nonsense.

devilbunny: Irrelevant to them. A radiologist is on the hook for missing a tiny possible tumor in a scan for a blood clot.They like to show off occasionally. We had a rectal foreign body that was described as a Phillips-head screwdriver. I was hoping to catch them out by noticing it was Pozidriv, but it was in fact a Phillips.

lapcat: Do you think this would help?The CEO is an employee of the board of directors and the stockholders. An AI CEO would no doubt be as ruthless as a human CEO, if not more so. In other words, I wouldn't anticipate any improvement in CEO behavior.

squidhunter: If I was going to reduce labor costs by +1M/year, I would rather eliminate 1 CEO then 10 radiologists. I would much rather have 1 unemployed CEO in society than 10 unemployed radiologists. At the very least, "AI" should replace through attrition rather than direct layoffs...

yread: Persuade someone to run a prospective trial and show the outcomes. Everything else is bullshit

endymi0n: Well, let's not forget the conflict of interest on the other side as well, of someone having invested decades of professional experience into a very lucrative field already getting obliterated by AI in some narrow fields.Getting rid of radiologists is as much nonsense and saber rattling as suggesting using AI would harm patients.The answer is clearly just the same as in software development or any other AI impacted field: Let the best professionals handle 10x+ the volume. What that means for all the rest of employees is the question of the century though...

teeklp: > Getting rid of radiologists is as much nonsense and saber rattling as suggesting using AI would harm patients.Did a chatbot tell you that? What makes you think it is so?

mcphage: > a human mises a cancer, that 10 out of 10 radiology models say it's there with 99% confidenceI think the cases where judgements differ—either between humans or AI or both–will be the difficult to discern cases, where no human and no LLM will have 99% confidence.

Fellow panelist David Lubarsky, MD, MBA, president and CEO of the Westchester Medical Center Health Network, said his system is already seeing great success in deploying such technology. The AI Westchester uses misses very few breast cancers and is “actually better than human beings,” he told the audience.“For women who aren’t considered high risk, if the test comes back negative, it’s wrong only about 3 times out of 10,000,” Lubarsky said.

Molitor5901: Fellow panelist David Lubarsky, MD, MBA, president and CEO of the Westchester Medical Center Health Network, said his system is already seeing great success in deploying such technology. The AI Westchester uses misses very few breast cancers and is “actually better than human beings,” he told the audience.“For women who aren’t considered high risk, if the test comes back negative, it’s wrong only about 3 times out of 10,000,” Lubarsky said. Sounds like 3 wrongs are an acceptable level of risk for this CEO. It would be interesting to put radiologists up against AI to see which have better results, but I would still rather a human read my chart and then have AI give the second opinion, rather than the other way around.