I currently split my time between two worlds. I see patients in clinic and also work on AI and innovation in the health system. Most days, the dichotomy is an asset. Some days, it feels like it is two different jobs that share one calendar.
AI has closed much of the knowledge gap in medicine and did it faster than expected. The chart review, the differential diagnoses, the literature search, it is all retrievable in a few seconds. What hasn’t been closed is the judgment gap. This is the intangible skill that is built from years of sitting with patients and watching what actually happens both before and after decisions are made. Patients trust us with their bodies. However, that trust is tied to judgment, not just our ability to collect data. In clinical medicine, we develop a sense of when a patient is sick, even though the data doesn’t explicitly tell us so. For example, we would notice the labs and vitals are fine, but our gut tells us something is off. We also recognize when the story doesn’t make sense, i.e., the story and the presentation do not fit.
Rock Health’s research found that even among people who use AI chatbots for health information, 85 percent still trust what their clinician tells them, compared to 56 percent for the chatbot. They use the chatbot but trust their physician. Trust is the true value proposition.
As we build clinical AI products, patients get more and faster access to information. So do we. I am all in on AI; I am an AI advocate. But medicine used to be a one-way door: You trained, you practiced, and mostly you stayed unless there was some unforeseen event. Now the hinges on the door have been changed, and it swings both ways. A handful of venture firms run paid fellowships specifically for MD and PhD candidates. At the other end of the career spectrum, physicians are leaving clinical practice roughly nine years earlier than they did in 2008. These are two separate extraction points in the workforce, and the reasons behind each are multifactorial. I see colleagues exiting for industry, startups, or leaving medicine altogether. Medicine isn’t just losing people to apathy and burnout. It’s losing them to optionality they never had before.
I didn’t want to choose between the two worlds, so I built a role that doesn’t ask me to sacrifice one for the other. I still see patients. I also work on AI and innovation in my health system. Yes, I’m checking and calling out my privilege here. That option isn’t available to everyone, yet. In order to combine the two roles, I had to find a path that straddles both worlds with different languages and expectations. But I don’t think enough of us are talking about what optionality actually means for our profession. Optionality is a reality for this next generation of physicians. What will medicine look like in ten years if some of us keep choosing the other door? Maybe it’s a selfish question. I would like my own future physicians to have acquired the knowledge as well as the clinical experience to have judgment. Then I will trust.
Just my 20 cents (based upon current inflation).
Jennifer Miles-Thomas is a distinguished urologist and health care executive who serves as vice chair of integration and innovation at Northwestern Medicine. Her clinical and leadership expertise spans medicine, business administration, and organizational innovation.
She earned her Doctor of Medicine from Northwestern University’s Feinberg School of Medicine and completed residency and fellowship training in female urology at the James Buchanan Brady Urological Institute at The Johns Hopkins Hospital. Building on her clinical acumen, she earned an MBA in Entrepreneurship and Innovation from the Massachusetts Institute of Technology, equipping her with a dynamic skill set to drive strategic growth and improve patient care.
Recognized for her vision and dedication, Miles-Thomas continues to shape the future of medicine by blending rigorous clinical knowledge, financial governance experience, and transformative business and AI strategy. She shares updates on LinkedIn, Instagram, and X.
