{
  "source": "Cooked Index — occupational AI risk register",
  "page": "https://cookedindex.com/jobs/general-internal-medicine-physicians/",
  "methodology": "https://cookedindex.com/methodology",
  "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.",
  "scored_at": "2026-08-11",
  "model": "claude-opus-5",
  "occupation": {
    "title": "General Internal Medicine Physicians",
    "soc_code": "29-1216",
    "category": "Healthcare",
    "us_employment": 67150,
    "median_annual_wage": 256560
  },
  "verdict": "SAFE",
  "risk_resistance": 82,
  "contested": false,
  "near_boundary": false,
  "dimensions": {
    "task_resistance": 13,
    "embodiment": 14,
    "liability_shield": 19,
    "trust_premium": 18,
    "judgment_accountability": 18
  },
  "reasoning": {
    "task_resistance": "Differential generation, guideline lookup, med-reconciliation checks and the entire note-and-coding layer are already being drafted by machine, but the parts that fill the actual visit — palpating an abdomen, deciding whether the dyspneic 78-year-old on five drugs goes home or gets admitted, re-interviewing a patient whose history changes on the third telling — hold the score at 13 rather than 16, because the documentation half of the job is genuinely going.",
    "embodiment": "An internist is physically at the bedside auscultating, doing rectal and breast exams, draining an effusion or placing a line on the floor, and rounding through rooms with contagious patients — real hands-on work, but in a hospital or clinic with equipment, nursing support and lighting, which is why this sits at 14 rather than in the linesman-and-roofer high teens.",
    "liability_shield": "State medical licensure plus DEA registration means the internist's own signature is on every controlled-substance script, admission order, DNR discussion and discharge summary, and a malpractice claim names that physician personally — near the ceiling, short of 20 only because hospital employment and institutional coverage absorb some exposure that an independent practitioner carries alone.",
    "trust_premium": "Continuity panels built over years are the mechanism by which patients disclose the drinking, the missed doses and the symptom they were embarrassed to mention, and adherence to a statin or a colonoscopy referral tracks who asked — an 18 rather than 20 because hospitalist and inpatient internists routinely care for patients they meet that morning.",
    "judgment_accountability": "Deciding how aggressively to treat a frail patient with CKD, heart failure and dementia — where guidelines conflict, the family disagrees, and code status is unresolved — is a call with no protocol and mortality on the other side of it, which is what an 18 looks like; not 20 because much of the panel is protocolised hypertension, diabetes and screening."
  },
  "rationale": "Internists spend most of their day on things AI cannot do alone: physical examination, in-person assessment of an unreliable narrator, weighing comorbidities and patient preferences, and signing prescriptions and admission decisions under personal license. AI is already eating the documentation layer — notes, coding, prior-auth letters, literature summaries, differential generation, guideline lookup — which changes the workday more than it changes the headcount. Ambulatory internists with heavy panel management face more AI-driven triage pressure than hospitalists doing bedside acute care.",
  "outlook": "By 2035 internists will see AI handle most documentation and first-pass triage while demand grows from an aging population — the job persists but skews toward complex, in-person, accountability-heavy encounters.",
  "what_would_raise_it": {
    "levers": [
      {
        "dimension": "liability_shield",
        "change": "State medical board or legislative rules explicitly barring autonomous AI from diagnosis/prescribing and requiring a named licensed physician of record to review and sign AI-generated recommendations — as in the pattern of California AB 3030 (2024, AI-generated patient communications must be disclosed and reviewable) and Texas/Illinois bills restricting AI clinical decision-making without physician sign-off. Also DEA/state rules keeping controlled-substance prescribing to a licensed prescriber personally.",
        "plausibility": "already happening",
        "would_add": 1
      },
      {
        "dimension": "task_resistance",
        "change": "Task-mix shift: documentation, coding, prior-auth and guideline lookup are the routine tier and are already being absorbed (Abridge, Nuance DAX). If they go entirely, the residual day is undifferentiated-complaint workup, multi-morbidity trade-offs, goals-of-care conversations and admit/discharge calls — the tier current models cannot close. Watch for panel sizes rising while visit length for complex patients also rises.",
        "plausibility": "already happening",
        "would_add": 3
      },
      {
        "dimension": "judgment_accountability",
        "change": "Payer and hospital adoption of formal AI-override documentation requirements — e.g. a requirement that the attending record a rationale whenever an AI sepsis/deterioration alert or utilization-review recommendation is not followed, making the physician the explicit owner of the deviation. Already appearing in Epic deterioration-index workflows and CMS conditions-of-participation discussion.",
        "plausibility": "plausible",
        "would_add": 2
      },
      {
        "dimension": "trust_premium",
        "change": "Growth of direct primary care and concierge internal medicine, where the sold product is named-physician continuity; and payer/employer contracts that price a human continuity relationship separately from AI-triaged 'virtual first' tiers. Also malpractice insurers offering premium credits only where a physician conducted the in-person encounter.",
        "plausibility": "plausible",
        "would_add": 2
      }
    ],
    "ceiling_note": "Already at 82; liability_shield, trust_premium and judgment_accountability are near their practical maxima, so realistic headroom is a few points from task-mix shift, not a category change. The real risk here is not displacement but scope reallocation — NPs/PAs plus AI absorbing the ambulatory panel-management tier, shrinking headcount without lowering any dimension score."
  },
  "adjudication": null,
  "employment_history": {
    "points": [
      {
        "y": 2019,
        "emp": 44610,
        "wage": 201590
      },
      {
        "y": 2020,
        "emp": 50600,
        "wage": 239200
      },
      {
        "y": 2021,
        "emp": 58260,
        "wage": 239200
      },
      {
        "y": 2022,
        "emp": 67220,
        "wage": 214460
      },
      {
        "y": 2023,
        "emp": 67210,
        "wage": 223310
      },
      {
        "y": 2024,
        "emp": 66640,
        "wage": 236350
      },
      {
        "y": 2025,
        "emp": 67150,
        "wage": 256560
      }
    ],
    "from": 2019,
    "to": 2025,
    "change_pct": 50.5,
    "comparable_from": 2019,
    "spans_soc_revision": false
  },
  "pivots": [],
  "license": "https://cookedindex.com/terms"
}