Will The AI Jobpocalypse Hit Healthcare?

It Depends on Which Jobs You’re Talking About

Are we on the verge of experiencing an AI-driven healthcare “jobpocalypse”? Just as “nobody knows anything” when it comes to whether we’re in a healthcare AI bubble (a topic I covered earlier this month), nobody can say for sure what the impact of AI will be on employment.

Despite the uncertainty, I believe the contours of AI’s impact on healthcare jobs are beginning to take shape. Given that the healthcare industry employs approximately 12% of the U.S. workforce (nearly 20 million people), what happens in healthcare will have a ripple effect throughout the broader economy. My prediction is that AI will lead to the loss of hundreds of thousands of healthcare jobs, but few of these will be among physicians, allied health professionals (AHPs), and nurses, at least in the next decade. Here’s why:

Healthcare Has Created Many Jobs – Mostly in Non-Clinical Areas

Over the past few decades, healthcare has been America’s most reliable engine of job creation. However, the growth in non-clinical positions has far outpaced that of clinical jobs.

Source: Mother Jones magazine.

You can see the evidence of this everywhere. Wander into the billing department of most large health systems, and you’ll witness hundreds of people optimizing documentation, drafting prior auth requests, and otherwise pushing reams of paper, often into fax machines. Amble over to the quality department, where you’ll see scores of workers reviewing charts for data to populate quality measurement spreadsheets, pay-for-performance schemes, and national registries in areas like interventional cardiology and transplantation. Head over to the population health department, whose personnel are struggling to remind patients that they’re overdue for a mammogram or a colonoscopy. The call center… well, you get the picture.

Will all these people be replaced by AI? Of course not. However, hospitals and healthcare systems operating under increasingly tight margins will inevitably push to hire fewer staff members, using technology to augment the work of those who remain.

Healthcare leaders are reluctant to fess up to a goal of reducing their headcount. In my research for A GIANT LEAP, one leader of an AI start-up told me this: “I’ve seen chief operating officers of health systems turn to their board and say, ‘We’re going to reduce our labor expenses.’ And then they turn to their staff and say, ‘None of you are losing your job.’ How does that work?”

In a 2024 segment on The Daily Show, Jon Stewart called out this kind of doublespeak as only he can. He began the segment by showing a clip of Microsoft CEO Satya Nadella: “It’s not about replacing the human in the loop. In fact, it’s about empowering the human… It’s an assistant.” Then another clip, this of Brian Chesky, CEO of Airbnb: “So this is like productivity, without the tax of more people.”

“Ahhhhh, the people tax!” said Stewart. “Formerly referred to as employees.”

The Impact of AI on Administrative and Operational Jobs

While administrative and operational jobs have expanded most rapidly, they’re also the most susceptible to AI replacement. The cuts have already begun. At UCSF Health, a decade ago, we started hiring human scribes to assist our busiest ambulatory clinicians in documenting their patient visits. At the program’s peak, about 100 of our busiest clinicians had a scribe – often a pre-medical student on a gap year. Today at UCSF, thousands of our doctors are now using scribes – but it’s no longer a 22-year-old pre-med supplied by a scribe staffing company; it’s an AI scribe supplied by a company named Abridge. Our clinicians are quite happy with their AI scribes (though some tell me they miss the opportunity to mentor the human scribes), and our expenses are a fraction of what they once were.

The displacement of human workers performing non-client-facing work – particularly entry-level workers – seems certain to be mirrored in every knowledge-based field, such as accounting, consulting, law, and software development. If AI can do the work at a fraction of the cost, these job losses – and the human toll they will take – seem inevitable. The fact that there is little discussion of policy responses (such as retraining programs or guaranteed income) on the congressional or White House agendas is a troubling sign of how unserious our politics has become.

How About Jobs for Nurses, AHPs, and Physicians?

In contrast to the major cuts in administrative staff, I predict that very few doctors, nurses, or AHPs will lose their jobs, at least over the next decade. For nurses in the hospital, much of their work involves administering medications, assisting patients with toileting and mobility, inserting catheters and IVs, conducting complex assessments, counseling patients and their families, and responding to emergencies. For the foreseeable future, it’s more likely that AI and robots will assist nurses in performing their jobs more effectively – enabling them to practice closer to the top of their license – than replace those jobs entirely.

For physicians, even fields seen as highly vulnerable to job replacement by AI (particularly radiology and pathology) have proven exceptionally resilient. If you’d asked me 15 years ago which would come first: our radiologists would be unemployed, or I’d sit in the back seat of a driverless car without giving it a second thought, I would have assumed that the radiologists would be toast. Yet in San Francisco, we can’t hire radiologists fast enough, while Waymos are literally everywhere. (In my book, I describe why radiologists have been surprisingly shielded from job replacement.)

In fields like mine – hospital medicine – significant job displacement also seems highly unlikely. While the work centers on diagnosis and therapeutics (areas in which AI is likely to offer significant assistance), it’s the surrounding complexity that makes physicians irreplaceable: coordinating care across shifting teams, discussing options with patients and families, and managing multiple coexisting illnesses.

As for specialist clinicians, robust knowledge tools like OpenEvidence will obviate the need for some specialty consults by allowing generalists to access expert-level guidance directly. However, in most of the markets I’m familiar with, specialists are already in short supply. Even a 10-20% drop in consult volume won’t lead to unemployment – it will just ease an existing shortage. And procedures, which are unlikely to be automated anytime soon, will continue to require specialist expertise.

The picture in primary care is even clearer. The nationwide shortage of primary care physicians is so dire that AI is far more likely to keep these clinicians sane and employed than replace them. In fact, one hope for primary care is that AI can handle the rote, algorithmic work – routine vaccinations, straightforward management of hypertension and cholesterol – thereby freeing clinicians to focus on the complex, relationship-driven care that defines the field.

Why Are Physicians So Hard to Replace?

Another obstacle to replacing patient-facing healthcare workers is what is sometimes referred to as the “Doorman Fallacy.” As UNC physician Spencer Dorn recently wrote in Forbes:

“A hotel that replaces doormen with automatic doors may save money, while overlooking the other valuable functions doormen provide, such as hailing taxis, providing security, welcoming guests, and signaling the hotel’s status.”

Similarly, AI mammography software may still require a human colleague – to perform quality control, read scans that the AI can’t quite sort out, or interact with referring physicians and patients from time to time. Replacing tasks is one thing; full-on job substitution is surprisingly hard to accomplish.

Furthermore, our current malpractice system hinges on whether a responsible physician was following the standard of care. Could the paradigm change so that one would sue the AI company or the healthcare organization that replaced the physician with an AI agent? Eventually, yes, but not anytime soon. Similarly, today’s billing system requires clinicians to drop a charge.

The Politics of Job Replacement

And then there’s politics. If the nursing profession begins to see significant job losses, you can be sure we’ll see significant pushback, particularly by nursing unions. In fact, in 2024, the nation’s largest nurses’ union, National Nurses United, declared its objection to “unproven AI.” In certain states (California is one of them), mandated nurse-to-patient ratios would have to be modified by the state legislature before hospital nurses could be replaced by AI.

While few doctors are unionized, you can also expect intense pushback if physicians perceive a threat to their income, status or jobs. It seems likely that their objections will be framed as concerns about patient welfare rather than self-interest, and it will be nearly impossible for the media, politicians, and the average patient to distinguish between the two.

For those of us rooting for AI to help rescue healthcare from its current crisis, the likely preservation of physician, AHP, and nurse employment matters enormously – not just morally, but strategically. Yes, every job loss deserves our empathy and attention. However, in the complex politics of healthcare transformation, a laid-off clinician will inevitably garner more attention and carry more weight than a laid-off call center worker. If physicians and nurses feel that their jobs are secure, they’re far more likely to embrace AI as a genuine ally rather than viewing “AI is here to help you” as corporate doublespeak masking a threat. That clinical acceptance may prove essential to AI’s successful integration throughout the healthcare ecosystem.

The Bottom Line

Questions about AI’s impact on jobs run deep, emotions run high, and the uncertainty is unsettling. And we can’t ignore the human factor: I don’t know anyone who would accept learning that they have cancer, diabetes, or kidney failure from a chatbot, no matter how brilliant the technology or how favorable the ROI looks on a spreadsheet.

As we grapple with these complex considerations and fears, we must return to a fundamental principle: healthcare exists to maximize human health at the lowest sustainable cost, not to preserve employment. That doesn’t mean we should be indifferent to job displacement – far from it. But it does mean that our ultimate measure of success must be better, more accessible care, even when achieving it demands difficult tradeoffs.