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Comment by engineercodex | Hacker News Reader

We all know this isn’t replacing doctors. We do know that when applied correctly, this will assist doctors and other clinical specialists in their work. With doctor burnout at all time highs, I think stuff like this is amazing.

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> We all know this isn’t replacing doctors. We do know that when applied correctly, this will assist doctors and other clinical specialists in their work.

Let's say a clinic currently has eleven doctors and is able to treat X number of patients per week. Let's say one of them retires, and instead of finding a human replacement, the remaining ten doctors choose an AI clinical assistant to free up 10% of their workload. Now it only takes ten AI-assisted doctors to continue serving the same number of patients as eleven doctors used to do.

This is just an example to show that there is no meaningful difference between "assisting" and "replacing". Any time an assistant, AI or not, takes some workload off somebody's plate, they have partially replaced them, and it adds up.

Except there aren’t enough doctors in many places. Also physician performance varies widely. So really this won’t replace doctors, but hopefully patient care will be affected positively. Doctors aren’t always brilliant outside their field and AI “assistance” can turn out to be a clever troll sometimes.

Yeah, I see this "not replacing, assisting" argument all the time, and it just doesn't work. If you can do more with fewer people, fewer people will be employed for the same task. In the past, nearly everyone was a farmer. We're not all farmers with, like, really easy jobs now because the machines do the boring bits. No, there are far fewer farmers.

For doctors, as a sibling comment mentions, there’s way more medical demand than doctor-time available.

This isn’t even considering quality of care, only quantity.

For other professions, if there’s already a glut of supply,… well, we don’t really need more ads or reality tv shows or sensational/viral clickbait.

1. There is a meaningful difference between replacing and assisting. Replacing implies being able to take over the entire function. Technology that assists doctors with one part of their function, or process, can improve their output but is not capable of producing like-for-like output on its own. So the question of whether AI can replace or only assist doctors is very relevant to determining its impact on the role. Power tools didn't replace tradesmen, for example. If AI was able to replace doctors, then your clinic would be able to scale down to 0 rather than 10.

2. If a clinic can use an AI tool to make doctors 10% more productive, doctors become worth more rather than less. Firms are incentivized to hire more rather than less in this scenario. What you're invoking here is the "lump of labor" fallacy. There are market conditions where increasing efficiency really does reduce quantity demanded, but it's not clear that medicine really is one. As far as I can tell, far from there being a fixed lump of medical work, the general population in most of the West is under-serviced and struggles to get reliable, timely, cost-effective access to medical expertise.

Whether or not there is pent-up demand for healthcare, the emergence of AI clinical assistants, like any other form of efficiency increases, effectively expands the supply of healthcare services. In a free market, an increase of supply lowers the price at equilibrium. And as their salaries go lower, fewer people become interested in joining the profession.

We saw this play out in agriculture, in manufacturing, and now it is starting to happen in some services. I do not understand why would we think it will be any different this time around.

In theory, yes. But in practice, at least here in Eastern Europe, there is such a shortage of doctors that even if they became three times more productive, there wouldn't be any meaningful changes in demand. For example, I haven't had a personal doctor for the past five years because they don't have any free capacity. Last month, I called the doctor twice because my child was sick, and they told me I shouldn't call them so often. So I think we're a long way from that happening.

>increase of supply lowers the price at equilibrium

The thing you're missing here is that "healthcare services" and "doctor's labor" aren't the same unit. Ceteris paribus, efficiency increases allow the price of healthcare to decrease while the price of doctor's labor increases. The thing that makes this non-contradictory is that a single doctor can now produce "more" healthcare. Economics says the opposite of what you think it does here. Increasing productivity drives expansion in market size, which drives up the ratio of value in the market to its labor inputs which drives up salaries.

Like I said, there might be important real-world reasons why these scenarios won't play out in medicine the way the theory predicts. But so far, you haven't provided any.

Manufacturing has also seen the opposite of what you are saying here. Global manufacturing production value has exploded over the last century, quite literally lifting billions of people out of abject poverty. In particular the last 3 decades of enormous per capita income increases in China have been driven by industrialization. I'm guessing you're taking a US-centric view that is exclusively focused on the local collapse of US manufacturing. This is to do with globalization and free trade, not improvements to labor efficiency.

There is a difference, but with an unwritten assumption: that the AI can do all the things the doctor can do.

If the AI can't do all the things that a doctor can do, then even when it can take up the slack for one doctor retiring, that doesn't tell you anything at all about whether or not it can take up the slack for two retiring.

Right now there's more work to be done than there are doctors to do it; this means that the same number of doctors are getting more things done as the AI improves… but not infinitely more, because there's still stuff the current AI can't do, that only humans can do.

We have a lot of things where technology has fully saturated demand: in food, this is why we've got an obesity problem in much of the world[0]; in medicine, this is how we wiped out smallpox entirely, and are very close to wiping out a few other diseases entirely; in telephony, this is why video conference calls are basically free.

But in each of those fields, there are other things we still have demand for, they're not complete post-scarcity: restaurants, old age, and bandwidth costs are still a thing.

[0] not so for transport, which is one reason why we simultaneously have some people starving

I don't think I want to have diagnostic support from an LLM. Perhaps it works most of the time but then you wake up with 13 fingers. The "battle" of Gemini vs GPT-4 doesn't really gain too much.

There are quite good specialized systems for medical applications that were thoroughly tested and vetted against quite high barriers for entry.

I hate the approach of ad companies to approach medical problems. Of course you need patient data for clinical studies, but far more interesting would be to collect data that hint to medical indications and offering up this knowledge to doctors that cannot know about all of them.

LLMs probably will just grow a new generation of hypochondriacs because they certainly will never say that you are healthy if diagnostic supports ever make it into production.

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