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Medical AI is evolving faster than the legal system can regulate it. Richard E. Anderson, CEO of The Doctors Company, the nation’s largest physician-owned medical malpractice insurer, argues that the gap between what AI can do clinically and what courts are ready to judge has created a difficult position for physicians, and that it will take a long time for the system to catch up. This episode is based on his article “The future of U.S. medicine: 10 health care trends in 2026,” published on KevinMD. You will hear why following an AI recommendation that diverges from the current standard of care can put a physician in legal jeopardy, why Anderson has seen almost no AI-related lawsuits so far despite widespread clinical use, what physicians should document every time they choose not to follow an AI recommendation, and what the 17-year lag between scientific discovery and standard-of-care adoption means for anyone practicing with AI today. Listen for a grounded read on medical AI heading into 2026.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Richard Anderson. He’s the CEO of the Doctor’s Company, which is the nation’s largest physician-owned medical malpractice insurer, and a longtime partner of KevinMD. Today’s KevinMD article is “The future of U.S. medicine: 10 health care trends in 2026.” Richard, welcome back to the show.

Richard E. Anderson: Thank you. It’s a pleasure to see you again.

Kevin Pho: All right. Let’s jump right into your article. For those who didn’t get a chance to read it, tell us what it’s about.

Richard E. Anderson: Well, it’s looking ahead over the next year and then more broadly, a little bit further than that, but the pace of change in health care is so rapid that long-term predictions are harder to make.

I think, speaking broadly, this is a difficult time to be a physician in the United States, and it’s difficult for a couple of reasons. One is the very rapid evolution of technology, the uncertain impact of AI. The only thing that is certain is that it’s going to have a profound impact on the way medicine’s practiced, but it’s uncertain whether that’ll be good, bad, or indifferent. And underlying all of that is the essentially permanent state of instability of the way health care is financed in the United States.

The cost of health care and the impact on access to health care are problems that have been with us for many years, but they’re getting more and more acute as costs continue to rise and government makes changes in the way that it is willing to finance health care. And the way government is willing to finance health care is critical, since today the federal government writes about 55 percent of the checks for all the health care in the United States.

So if we look at some of the specific predictions, we can start with AI, since besides finance, that’s probably most top of mind. And I think there’s a conundrum here, and we’re acutely aware of it as a medical malpractice insurance company owned by our physicians. If you use AI and AI suggests a clinical course which turns out to be beneficial and you have a good outcome, well, of course there’s no problem. There’s no injury. Everybody’s happy.

If AI suggests something that is different than what you believe to be the standard of care, and you follow the recommendation of AI, and the outcome is adverse, well then medically, legally, you’re in very deep water, because you have actually deviated from the standard of care to follow AI. And so, paradoxically and almost predictably, our medical legal system is going to take a long time to catch up with the realities of AI.

AI is so profound and is evolving so quickly that my sense is, as physicians get more comfortable with it, as the systems themselves get better, that it actually will become the standard of care. And when that happens, well then this issue goes away. But until it happens, the specter of liability for following recommendations from AI that are discrepant with the current standards of care puts the physician in medical legal jeopardy. So our legal system is going to slow the broad adaptation of AI.

Speaking more broadly, we can talk about digital transformation. Incredibly, we’re in the middle of a $1 trillion migration in our health care system to digital medicine, which is again potentially terrific in the sense that it’s much more accessible. Advances can be integrated more rapidly in a digital system than in our conventional way. We all have this notion that it takes 17 years from the time a clinical trial or a laboratory finding potentially changes the standard of care to the time that it’s adapted. Well, 17 years is just too long. Digital transformation can certainly shorten that time in a number of ways, including more rapid clinical discoveries and scientific discoveries. But again, as I mentioned, it’s predictable that our legal system will not keep up with the pace of change, and that that’ll always be a drag on the way physicians are able to practice medicine in this country.

All of this leads to widening access gaps to care. For example, digital medicine will be very important. AI will be very important. Not everyone in our country has access to those kinds of things. So that’s certainly an issue. Related to those gaps, related to the digital gap, are employment gaps. In other words, it’s interesting that health care is the fastest growing segment of the American economy, which is even more remarkable because health care is such a large percentage of the American economy. On the other hand, growing employment in health care is good for job creation, but it’s adding costs to health care. And so again, the question is, how do we balance those things?

Medical liability reform is another way of saying that the courts will need to catch up. Eventually they will catch up, and when they catch up, they may or may not do it right, but at least the courts will ultimately get to predictable standards of outcomes, so that physicians know what is felt to be legally appropriate and what is potentially outside the bounds of allowable clinical practice.

Kevin Pho: Well, let me stop there, just because you brought up a few topics that we can certainly talk more about. Every time we talk about these health care trends, there’s always something that is fundamentally changing health care. What do you think makes AI different? Why is this change, I’m inferring from what you’re saying, why is this change bigger than some of the prior changes whenever we talk about health care trends?

Richard E. Anderson: Yeah, that’s a great question. And I think there are a couple of reasons for that. One is it doesn’t require special equipment. Obviously the infrastructure is extraordinarily sophisticated, but the truth is you can access it on your phone, your PC, and so it doesn’t require technical skills to access even very sophisticated AI models.

Second, there’s a lot of competition in this field. In other words, we have the mega tech companies, but there are already more than a thousand AI programs that have been approved by the FDA. So it’s moving very quickly. And so the ease of adaptation, the ease of use, and also what I might call the face validity of AI. It’s very powerful, right? You ask a question, you get a very specific answer, and if you want to refine that answer, you ask another prompt and another question. It’s very, very convincing.

We all talk about, and have been inured to talk about, the problems of hallucination in AI, but in fact, number one, with the newer programs that’s getting less of a problem. And number two, the very rapid adaptation of the medical model OpenEvidence, the AI model, which is not only an AI model, but it’s based on well-documented literature inputs, which in fact are incorporated into the answer to your question. And you can ask very sophisticated, very specific questions to OpenEvidence and get answers that really appear to be really outstanding, even state of the art, very, very hard to match.

And by the way, OpenEvidence went from a gleam in somebody’s eye to a $15 billion company. OpenEvidence has been so widely adopted so quickly by physicians that it’s really changing the way, I want to say medicine’s practiced, that’s probably a little bit too broad, but it’s changing the way physicians seek information. UpToDate had that same kind of revolutionary impact on the way physicians could obtain information quickly. OpenEvidence is really kind of the next generation of that, and it’s very profound.

So I do think the impacts are going to be very positive ultimately. They are very positive ultimately. It’s just trying to integrate them into the financial and legal strictures, as well as the operational and organizational strictures in which medicine’s practiced today, is going to be challenging for a health care system that’s as rigid and as regulated as ours is.

Kevin Pho: Do you feel that these AI tools are being adopted without thinking about the potential repercussions that they may incur, or that people may not even know about? The repercussions may be unintended. So do you think that they’re being adopted too quickly before people can think about some of the consequences of adopting them?

Richard E. Anderson: Yeah, it’s very hard. It’s hard for me to know the answer to that, because I think where AI is being used, now we’re talking about the whole medical system, we’re talking about everything from the most elite academic medical centers to individual practitioners practicing in rural aspects of the United States. So it’s difficult to generalize on it. But it’s also true that the pace of change is hard for anyone to keep up with.

And again, I think that the thrust of AI, clinical AI, scientific AI, is already tremendous benefit and is working dramatically in the lab. But clinical AI is evolving very rapidly. My sense is it’s going to be far more positive than negative. That’s my sense. But it will be very difficult for individual physicians or even academic medical centers to make firm judgments on which program is the best. Is this advice that I can really rely on, or is this just another way to look at a case but not necessarily the right way to look at a case?

I think all of those things are going to require quite a bit of experience, and the experience will differ whether you’re doing this as a solo practitioner working entirely on your own, to some large degree in a vacuum, or whether you’re part of a large integrated health care delivery system where you’ll have a lot of tech support, a lot of colleague input, and a lot of ability to collaborate with human specialists as well, to vet the recommendations that you’re getting. And again, I think it reflects the technology. It’s such an overwhelmingly dramatic technology, very easy to access, but almost impossible to understand as a technological point. And so there will be tremendous variations in how quickly and where and when it’s adopted across the United States.

Kevin Pho: Now, from your lens as a medical practice insurer, how are you preparing your physician clients from a medical malpractice standpoint? Are you seeing it as a net positive, because sometimes AI can find potential errors before they happen, or are you preparing them for that scenario that you mentioned where AI can potentially steer a physician awry and expose them to medical malpractice? So from your lens, how are you preparing your clients?

Richard E. Anderson: Well, that’s a great question. And let me just introduce my answer to that question by saying this. We have seen virtually no litigation that’s currently involving the use of AI. It’s a little bit surprising. It’ll come for sure, but we’re not seeing some sort of tide coming ashore of AI litigation, which is good.

I think that we want our physicians to be familiar with AI, to understand its strengths and weaknesses. We have our own publications about that. We have experts who provide articles that we distribute to our physicians. And of course, physicians are being inundated with AI from every place. No matter where they practice or how they practice, they’re getting lots of their input from all the places that physicians get input from. So it’s hard to be unaware of AI and what it’s doing.

Again, it will depend tremendously on how much it’s impacting your daily practice, depending on where and how that daily practice is. My sense is it will be positive. I think that as the technology continues to evolve, as physicians understand the strengths and weaknesses of it, that it will be a significant net positive. I don’t want to exaggerate, but if you suddenly have encoded in your phone the very best of a comprehensive overview of contemporary medical knowledge, it’s hard to see that that’s going to be a bad thing. In fact, it’s not going to be a bad thing.

The question is to make sure that we use it widely, and to make sure that in those cases where for whatever reason it provides results that are inappropriate or misleading for our patient, that we be in a position to not follow that advice and to understand why we’re not following that advice. And by the way, that brings us to a common problem in medical legal things. Physician judgment is still highly valued in court. And if your judgment is reasonable, even if your judgment is wrong, usually the court will say it was a reasonable judgment. Reasonable physicians could have made the same judgment, and there’s no liability in that case.

So it’s important that you document your reasoning. If you’re following AI when it’s discrepant from the standard of care, document why. If you’re not following AI because you believe the standard of care is more appropriate for your patient, great, just jot it down why you made that decision. And I think that’s important. It’s always important in medical legal cases, but it also is an important spur to our own thinking in terms of why we’re making these decisions.

Kevin Pho: Now, I know in your article you talked about 10 health care trends, right? I think we only have time to talk about one more. So let’s talk about one more. I’ll let you choose. What’s a health care trend this year, another one that physicians need to look out for and perhaps watch out for how it impacts their practice?

Richard E. Anderson: It’s challenging because there’s so much change. I think the largest issue is what happens to physicians’ trust going forward, that is, the public’s trust in physicians going forward. I think it’s absolutely critical that physicians maintain that trust. We believe that they will maintain that trust.

One of the things that is challenging now in this environment is the erosion of belief in science, from anti-vaxxers to some of the things that are happening at HHS under Secretary Kennedy. And to some degree, the undercutting and dismantling of American medical science is really very, very alarming. And that information goes directly out to consumers in daily newspapers. The effects on medicine are erosive and take a long time to be felt, because a grant that’s not funded today or withdrawn will have effects in the near future, but not today.

So I think that it’s critical that physicians maintain the doctor-patient relationship. It’s critical that government not be governed by political whims when we’re really talking about medical science and the health of the American population. I think it’s possible to do. I think we’ve seen some back and forth on some of the decisions that have been made, and that some of that back and forth is encouraging. And so in the long sense, I’m optimistic, in the sense that the information and the science and the technology are there to make health care better, faster, and even possibly cheaper, which would be terrific. That’s an opportunity that is there for us to take advantage of, and I am optimistic that, working together, the medical profession can and will do this. And it will be a tremendous step forward for the way health care is practiced in the United States, but also for the pleasure and gratification that physicians can take from patient care in the coming years.

Kevin Pho: I agree with your perspective that we do live, of course, in politically polarized times, and then there is also a devaluation of expertise in our culture. So when it comes to trust in the medical profession, what are some things that individual physicians can do in the exam room? Because sometimes they don’t have any power over policy, but what are some easy, actionable steps that your physician members or other physicians listening to you can do to maintain and increase that trust in the medical profession?

Richard E. Anderson: Yeah, that’s a great question. And I think some of them are pretty straightforward, and nothing I’m about to say is going to be revolutionary. But I think it’s the personal relationship that you establish with your patients. It’s being able to look them in the eye, understand what their concerns are, and communicate with them directly.

Some of the advances, ambient listening for computerized medical records and so forth, are very, very helpful, because they now allow the physician to actually look at the patient instead of looking at the computer. And that’s a very important thing. It’s very, very important. And I think the cacophony of the internet is a problem, but ultimately physicians virtually always have the best possible scientific information for making informed health care decisions, as long as they take advantage of that health care information and communicate it clearly to patients. Patients will benefit from that, and when patients benefit from that, of course it builds trust. And building trust is critical, as in any good doctor-patient relationship.

And again, one can think of that as one stability, which is that the foundation of good medical care is a good doctor-patient relationship. And that’s been true forever, and it’ll be more true than ever going forward.

Kevin Pho: We’re talking to Richard Anderson. He’s the CEO of the Doctor’s Company, the nation’s largest physician-owned medical malpractice insurer, and a longtime partner with KevinMD. Today’s KevinMD article is “The future of U.S. medicine: 10 health care trends in 2026.” Richard, let’s end with some of your take-home messages you want to leave with the KevinMD audience.

Richard E. Anderson: Yes, thank you. I think first of all, it’s a pleasure to be with you again. Second, this is a challenging time. It’s a challenging time in the world. It’s a challenging time in the country. It’s a challenging time with the remarkable degree of polarization that we have in the country and the undermining of science broadly, and medical science in particular.

Having said all that, the opportunities for improving health care going forward are there dramatically now, with newer technology, newer approaches, advances in the way health care’s delivered, all of those things. And getting the best available information directly into the hands of physicians and other clinicians in real time is there. That is all positive. All positive.

And so I think that we always have this paradox in the United States, which is that probably the best care available anywhere in the world is available in the United States. On the other hand, it’s not available all the time and to everyone in the country, and our goal, obviously, is to make that great health care available to all Americans who require it. We are getting closer, with new technology, new information, and perhaps new approaches to the way health care is delivered, we’re getting closer to being able to actually meet that very, very powerful and important goal.

Kevin Pho: Richard, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.

Richard E. Anderson: Thank you so much. Pleasure to see you again.